115 results found
Harpaz D, Bajpai R, Ng GJL, et al., 2021, BLOOD BIOMARKERS TO DETECT NEW-ONSET ATRIAL FIBRILLATION AND CARDIOEMBOLISM IN ISCHEMIC STROKE PATIENTS., Heart Rhythm
BACKGROUND: Accumulating data suggest blood biomarkers could inform stroke etiology. OBJECTIVE: We investigated the performance of multiple blood biomarkers to elucidate stroke etiology with a focus on new-onset atrial fibrillation (AF) and cardioembolism. METHODS: Between January and December 2017, information on clinical, laboratory parameters and stroke characteristics were prospectively collected from ischemic stroke patients recruited from the National University Hospital, Singapore. Multiple blood biomarkers (NT-pro-brain derived peptides [NT-proBNP], D-dimer, S100β, neuron-specific enolase [NSE], vitamin D, cortisol, interleukin-6, insulin, uric acid and albumin) were measured in plasma. These variables were compared with stroke etiology, and the risk of new-onset AF and cardioembolism, using multivariable regression methods. RESULTS: From 515 ischemic stroke patients (mean age, 61 years; 71% men), 44 (8.5%) patients were diagnosed with new-onset AF and 75 (14.5%) patients had cardioembolism. The combination of two laboratory parameters (total cholesterol ≤169 mg/dl and triglycerides ≤44.5 mg/dl) and three biomarkers (NT-proBNP ≥294 pg/ml, S100β ≥64 pg/ml and cortisol ≥471 nmol/l) identified patients with new-onset AF (negative predictive value [NPV] 90%, positive predictive values [PPV] 73% and area under curve [AUC] 85%). The combination of two laboratory parameters (total cholesterol ≤169 mg/dl and triglycerides ≤44.5 mg/dl) and two biomarkers (NT-proBNP ≥507 pg/ml and S100β ≥65 pg/ml) identified those with cardioembolism (NPV 86%, PPV 78% and AUC 87%). Adding clinical predictors, however, did not improve the performance of these models. CONCLUSION: Blood biomarkers could identify patients with increased likelihood of cardioembolism and direct the search for occult atrial fibrillation.
Soljak M, 2021, Occupation is still an important health determinant., BMJ, Vol: 372
Soriano JB, Kendrick PJ, Paulson KR, et al., 2020, Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet Respiratory Medicine, Vol: 8, Pages: 585-596, ISSN: 2213-2600
BackgroundPrevious attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017.MethodsUsing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs.FindingsIn 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–
Divakar U, Sathish T, Soljak M, et al., 2019, Prevalence of vitamin D deficiency and its associated work-related factors among indoor workers in a multi-ethnic Southeast Asian Country, International Journal of Environmental Research and Public Health, Vol: 17, ISSN: 1660-4601
Little is known about the effect of working conditions on vitamin D status in Southeast Asia, where vitamin D deficiency is common despite the presence of sunlight all year round in most places. We examined the prevalence of vitamin D deficiency and its associated work-related factors among indoor workers using the data of 213 participants (aged ≥21 years) from a workplace cohort study in Singapore. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L. Data on work-related factors, socio-demographic characteristics, and lifestyle habits were collected using standardized questionnaires. Clinical and biochemical measurements were performed using standard tools and protocols. Multivariate Poisson regression was used to examine the independent association of work-related factors with vitamin D deficiency. Mean serum 25(OH)D concentration was 59.6 nmol/L. The prevalence of vitamin D deficiency was 32.9% (95% confidence interval (CI): 26.6-39.6%). In the multivariate analysis, office workers (prevalence ratio (PR): 2.16, 95% CI: 1.12-4.16 versus control room workers), workshop workers (PR: 2.25, 95% CI: 1.05-4.81 versus control room workers), and night shift workers (PR: 1.31, 95% CI: 1.03-1.67) were at a greater risk for vitamin D deficiency. Workplace policies and wellness programs should encourage workers to take regular breaks to go outdoors for sunlight exposure and to consume adequate amounts of vitamin D-rich foods to maintain optimal vitamin D levels.
Visvalingam N, Sathish T, Soljak M, et al., 2019, Prevalence of and factors associated with poor sleep quality and short sleep in a working population in Singapore, Sleep Health, ISSN: 2352-7218
ObjectivesWe aimed to examine the prevalence of poor sleep quality and short sleep and their associated factors in a working population in Singapore.DesignThis is a cross-sectional analysis.SettingFour companies in Singapore were included in this study.ParticipantsParticipants included 464 full-time employees (aged ≥21 years).MeasurementsSelf-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Self-administered questionnaires were used to collect data on sociodemographic characteristics, health behaviours, medical history, chronotype, psychosocial factors, health-related quality of life (HRQoL) and occupational factors. Clinical measurements were performed using standard tools and protocols. Multivariate logistic regression was used to examine the factors associated with poor sleep quality (PSQI global score >5) and short sleep (<7 hours/night).ResultsThe mean age was 39.0 (SD: 11.4) years, and 79.5% were men. The prevalence of poor sleep quality was 42.5%, and 66.2% were short sleepers. Nearly three-fourths (71.3%) had at least one of these two conditions. Age, Malay ethnicity (vs. Chinese), chronic conditions, poorer mental health, stress at home or work and shift work were positively associated, and mental component summary of the HRQoL scale and work years in the current company were negatively associated with poor sleep quality. Age, Malay and Indian ethnicities (vs. Chinese), longer dinner-to-bed time, snacking between dinner and bed time, and poorer mental health were positively associated with short sleep.ConclusionsPoor sleep quality and short sleep were highly common in this working population in Singapore. Workplace policies should include education and intervention programmes to promote better sleep hygiene.
Sathish T, Dunleavy G, Soljak M, et al., 2019, Risk factors for non-communicable diseases at baseline and their short-Term changes in a workplace cohort in Singapore, International Journal of Environmental Research and Public Health, Vol: 16, Pages: 1-11, ISSN: 1660-4601
We aimed to examine the behavioural and clinical risk factors for non-communicable diseases (NCDs) at baseline and their changes over 12 months in a workplace cohort in Singapore. A total of 464 full-time employees (age ≥ 21 years) were recruited from a variety of occupational settings, including offices, control rooms, and workshops. Of these, 424 (91.4%) were followed-up at three months and 334 (72.0%) were followed up at 12 months. Standardized questionnaires were used to collect data on health behaviours and clinical measurements were performed by trained staff using standard instruments and protocols. Age-adjusted changes in risk factors over time were examined using generalized estimating equations or linear mixed-effects models where appropriate. The mean age of the participants at baseline was 39.0 (SD: 11.4) years and 79.5% were men. Nearly a quarter (24.4%) were current smokers, slightly more than half (53.5%) were alcohol drinkers, two-thirds (66%) were consuming <5 servings of fruit and vegetables per day, and 23.1% were physically inactive. More than two-thirds (67%) were overweight or obese and 34.5% had central obesity. The mean follow-up was 8.6 months. After adjusting for age, over 12 months, there was a significant increase in the proportion consuming <5 servings of fruit and vegetables per day by 33% (p = 0.030), who were physically inactive by 64% (p < 0.001), and of overweight or obese people by 15% (p = 0.018). The burden of several key NCD risk factors at baseline was high and some worsened within a short period of time in this working population. There is a need for more targeted strategies for behaviour change towards a healthy lifestyle as part of the ongoing health and wellness programs at workplaces in Singapore. View Full-Text
Dunleavy G, Sathish T, Nazeha N, et al., 2019, Health Effects of Underground Workspaces (HEUW) cohort in Singapore: study design and baseline characteristics, Epidemiology and Health, Vol: 41, ISSN: 2092-7193
The development of underground workspaces is a strategic effort towards healthy urban growth in ever-increasing land-scarce cities. Despite the growth in underground workspaces, there is limited information regarding the impact of this environment on worker’s health. The Health Effects of Underground Workspaces (HEUW) study is a cohort study which was set up to examine the health effects of working in underground workspaces. In this paper, we describe the rationale for the study, study design, data collection and baseline characteristics of participants. The HEUW study recruited 464 participants at baseline, of which 424 (91.4%) were followed-up at three months, and 334 (72.0%) after 12 months from baseline. We used standardized and validated questionnaires to collect information on socio-demographic and lifestyle characteristics, medical history, family history of chronic diseases, sleep quality, health-related quality of life, chronotype, psychological distress, occupational factors, and comfort levels with indoor environmental quality parameters. Clinical and anthropometric parameters including blood pressure, spirometry, height, weight, waist and hip circumference were also measured. Biochemical tests of participant’s blood and urine samples were conducted to measure glucose, lipids and melatonin levels. We also conducted objective measurements of an individual’s workplace environment, assessing air quality, light intensity, temperature, thermal comfort, bacterial and fungal counts. Findings from this study will help to identify modifiable lifestyle and environmental parameters that are negatively affecting worker’s health. The findings may be used to guide the development of more health-promoting workspaces that attempt to negate any potential negative health effects from working in underground workspaces.
Khaing NEE, Abuduxike G, Posadzki P, et al., 2019, Review of the potential health effects of light and environmental exposures in underground workplaces, TUNNELLING AND UNDERGROUND SPACE TECHNOLOGY, Vol: 84, Pages: 201-209, ISSN: 0886-7798
Martinengo L, Olsson M, Bajpai R, et al., 2019, Prevalence of chronic wounds in the general population: Systematic review and meta-analysis of observational studies, Annals of Epidemiology, Vol: 29, Pages: 8-15, ISSN: 1047-2797
Purpose Chronic wounds are a major public health challenge, but little is known about the true burden with studies reporting different estimates due to disparities in study designs and measurement methods. This hampers efficient resource allocation, planning and improvement of wound care Methods Our study aimed to pool prevalence estimates from a global perspective by systematically carrying out searches in MEDLINE, EMBASE, Cochrane, CINAHL, Global Health, and PsycINFO databases for papers reporting the prevalence of chronic wounds in adults, from January 2000 to June 2018. The included publications had to define wound chronicity by duration (≥3 weeks), and/or labelling the wounds as chronic, complex or hard-to-heal. Results Seventeen studies met the inclusion criteria, and 11 studies analysing chronic wounds in the general population were included in random effects meta-analyses to calculate pooled prevalence. Chronic wounds of mixed aetiologies (n=3) showed a pooled prevalence of 2.21 per 1,000 population, and for chronic leg ulcers (n=9) the prevalence was estimated at 1.51 per 1,000 population. Conclusions Our findings, aligned to previous studies reporting point prevalence of chronic wounds identified within the healthcare system, showed that the vast majority of chronic wounds in epidemiological studies are made up by chronic leg ulcers.
Lozano R, Fullman N, Abate D, et al., 2018, Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 2091-2138, ISSN: 0140-6736
BackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected fo
Su B, Newson R, Soljak H, et al., 2018, Associations between postoperative rehabilitation of hip fracture and outcomes: national database analysis (vol 19, 211, 2018), BMC MUSCULOSKELETAL DISORDERS, Vol: 19, ISSN: 1471-2474
Huang Z, Soljak M, Boehm BO, et al., 2018, Clinical relevance of smartphone apps for diabetes management: a global overview, Diabetes/Metabolism Research and Reviews, Vol: 34, ISSN: 1520-7560
AIMS: We assessed the number, proportion and clinical relevance of diabetes self-management apps in major languages spoken by ten countries with the greatest number of people with diabetes. METHODS: China, India, USA, Brazil, Russian Federation, Mexico, Indonesia, Egypt, Japan and Pakistan were identified as the ten countries with the largest number of people with diabetes based on the latest NCD-RisC survey. Android and iOS apps in the ten national languages were extracted with a search strategy. App titles and descriptions were systematically screened by trained reviewers, including apps specific for diabetes self-management and excluding apps for healthcare providers, general well-being, health and product promotion and traditional cure. Eighteen apps in the above languages were then downloaded based on availability and popularity, and assessed for clinical relevance to diabetes self-management with reference to current clinical guidelines. RESULTS: The diabetes-related search terms identified 3374 Android and 4477 iOS apps, where 1019 Android and 1303 iOS apps were screened as being relevant for diabetes self-management. Chinese and English language apps constitute above 80% of the diabetes apps, have more downloads, and more comprehensive clinically relevant functions compared to other languages. None of the apps assessed met all criteria for information provision and app functionalities, nor provided information cited from accredited sources. CONCLUSIONS: Our study showed that apps could play an important role in complementing multifaceted diabetes care, but should preferably be regulated, context specific and more tailored to users' needs with clear guidance for patients and clinicians about the choices.
Posadzki PP, Baipai R, Myint Kyaw B, et al., 2018, Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action, BMC Medicine, Vol: 16, ISSN: 1741-7015
Background: Our aims were to evaluate critically the evidence from systematic reviews as well as narrative reviewsof the effects of melatonin (MLT) on health and to identify the potential mechanisms of action involved.Methods: An umbrella review of the evidence across systematic reviews and narrative reviews of endogenous andexogenous (supplementation) MLT was undertaken. The Oxman checklist for assessing the methodological qualityof the included systematic reviews was utilised. The following databases were searched: MEDLINE, EMBASE, Web ofScience, CENTRAL, PsycINFO and CINAHL. In addition, reference lists were screened. We included reviews of theeffects of MLT on any type of health-related outcome measure.Results: Altogether, 195 reviews met the inclusion criteria. Most were of low methodological quality (mean -4.5,standard deviation 6.7). Of those, 164 did not pool the data and were synthesised narratively (qualitatively) whereasthe remaining 31 used meta-analytic techniques and were synthesised quantitatively. Seven meta-analyses weresignificant with P values less than 0.001 under the random-effects model. These pertained to sleep latency,pre-operative anxiety, prevention of agitation and risk of breast cancer.Conclusions: There is an abundance of reviews evaluating the effects of exogenous and endogenous MLT onhealth. In general, MLT has been shown to be associated with a wide variety of health outcomes in clinically andmethodologically heterogeneous populations. Many reviews stressed the need for more high-quality randomisedclinical trials to reduce the existing uncertainties.
Chang K, Lee JT, Vamos E, et al., 2017, Socio-demographic inequalities in the effectiveness of England's NHS Health Check, 10th European Public Health Conference Sustaining resilient and healthy communities, Publisher: Oxford University Press (OUP), ISSN: 1101-1262
Visvalingam N, Nang E, Divakar U, et al., 2017, ASSOCIATION BETWEEN SELF-REPORTED WORKPLACE LIGHTING QUALITY AND SLEEP QUALITY IN A MULTI-ETHNIC POPULATION IN ASIA, 29th Annual Scientific Meeting (ASM) of Australasian-Sleep-Association and Australasian-Sleep-Technologists-Association, Publisher: WILEY, Pages: 51-52, ISSN: 0962-1105
Gakidou E, Afshin A, Abajobir AA, et al., 2017, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet, Vol: 390, Pages: 1345-1422, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.FindingsSince 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smok
Hay SI, Abajobir AA, Abate KH, et al., 2017, Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet, Vol: 390, Pages: 1260-1344, ISSN: 0140-6736
BackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (
Fullman N, Barbar RM, Abajobir AA, et al., 2017, Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016, The Lancet, Vol: 390, Pages: 1423-1459, ISSN: 0140-6736
BackgroundThe UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.MethodsWe used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0–100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment.FindingsGlobally, the median health-related SDG index was 56·7 (IQR 31·9–66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6–88·9), Iceland (86·0, 84·1–87·6), and Sweden (85·6, 81·8–87·8) having the h
Chang K, Vamos E, Lee J, et al., 2017, Socio-demographic inequalities in cardiovascular risk management and early detection of vascular conditions by the nhs health check: a difference-in-differences matching analysis, Journal of Epidemiology and Community Health, Vol: 71, Pages: A3-A3, ISSN: 0143-005X
Woringer M, Jones Nielsen J, Zibarras L, et al., 2017, Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme, BMJ Open, Vol: 7, ISSN: 2044-6055
BackgroundThe National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients. AimsThe aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. MethodsWe developed an 85 item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65 item questionnaire with satisfactory content validity (content validity indices >=0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross sectional study between May 21 and July 28, 2014. ResultsFollowing analyses of data, we reduced the questionnaire from 65 to 26 items. The 26 item questionnaire constitutes 4 scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α = 0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α = 0.82) have satisfactory reliability (Cronbach’s α >=0.70). Healthy Eating Intentions (Cronbach’s α = 0.56) is below minimum threshold for reliability but acceptable for a three item scale. ConclusionsThe resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.
El-Osta A, Woringer M, Pizzo E, et al., 2017, Does use of point of care testing improve cost effectiveness of the NHS Health Checks programme in the primary care setting? A cost minimisation analysis, BMJ Open, Vol: 7, ISSN: 2044-6055
Objective: To determine if use of Point of Care Testing (POCT) is less costly than laboratory testing to the NHS in delivering the NHS Heath Check (NHSHC) programme in the primary care setting Design: Observational study and theoretical mathematical model with micro-costing approachSetting: We collected data on NHSHC delivered at 9 general practices (7 using POCT; 2 not using POCT). Participants: We recruited 9 general practices offering NHSHC, and a Pathology Services Laboratory in the same area. Methods: We conducted mathematical modelling with permutations in the following fields: provider type (HCA or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), consumables costs and variable uptake rates including rate of non-response to invite letter and rate of missed (DNA) appointments. We calculated Total Expected Cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters. Main outcome measures: We collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a Pathology Services Laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices. Results: TEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of CVD risk-score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment. Conclusions: TEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pat
Woringer M, cecil E, watt H, et al., 2017, Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study, BMC Health Services Research, Vol: 17, ISSN: 1472-6963
Background:Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England’s National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups.Methods:Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively.Results:Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs – namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men s
Moore E, Newson R, Joshi M, et al., 2017, Effects of pulmonary rehabilitation on exacerbation number and severity in people with COPD: An historical cohort study using electronic health records, Chest, Vol: 152, Pages: 1188-1202, ISSN: 1931-3543
BackgroundIn previous systematic reviews, predominantly of randomised controlled trials, pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. We aimed to compare rates of hospitalized and general practice (GP) treated AECOPD before and after PR.MethodsUsing anonymised data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared one year before and after PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR with those eligible and not referred.Results69,089 (64%) of the COPD patients in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. 62, 019 (89.8%) were not referred and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, people who were eligible and were referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient-year 95% CI: 2.66, 3.00) than those who were eligible but not referred (2.17 exacerbations/patient-year 95% CI: 2.11, 2.24).ConclusionsThis study found that less than 10% of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year after PR compared to those not referred or compared to the year before PR.
Asaria P, Elliott P, Douglass M, et al., 2017, Acute myocardial infarction hospital admissions and deaths in England: a national follow-back and follow-forward record-linkage study, Lancet Public Health, Vol: 2, Pages: e191-e201, ISSN: 2468-2667
Background Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. Methods We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100 000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. Findings Acute myocardial infarction was diagnosed in the first physician encounter in 307 496 (69%) of 446 744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52 374 (12%) admissions, and recorded only as a comorbidity in 86 874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135 950 death
Chang KC-M, Majeed A, Vamos EP, et al., 2017, The authors respond to "NHS Health Check: national evaluation findings and implications", CMAJ, Vol: 189, Pages: E173-E173, ISSN: 0820-3946
Asaria P, Elliott P, Douglass M, et al., 2017, Acute myocardial infarction hospitalisations and deaths in England: A national record-linkage study, The Lancet Public Health
Lee JT, Lawson KD, Wan Y, et al., 2017, Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence, PREVENTIVE MEDICINE, Vol: 99, Pages: 49-57, ISSN: 0091-7435
Akram A, Dunleavy G, Soljak M, et al., 2017, Beyond Health Apps, Utilize Patient-Generated Data, 23rd International Conference on Information and Software Technologies (ICIST), Publisher: SPRINGER-VERLAG BERLIN, Pages: 65-76, ISSN: 1865-0929
Moore E, Palmer T, Newson R, et al., 2016, Pulmonary rehabilitation for acute exacerbations of chronic obstructive pulmonary disease (COPD): A systematic review, European Respiratory Society Congress 2016, Publisher: European Respiratory Society, Pages: PA3771-PA3771, ISSN: 0903-1936
Background: Acute exacerbations of COPD (AECOPD) have a significant impact on healthcare utilisation, including physician visits and hospitalisations. The effect of pulmonary rehabilitation (PR) on hospitalisations for AECOPD is inconclusive.Methods: Medical databases were searched to assess the impact of PR on emergency hospitalisations for AECOPD. Cohort studies and randomised controlled trials (RCTs) reporting hospitalisations for AECOPD as an outcome were included. Meta-analyses compared exacerbation rates between eligible PR recipients and non-recipients before and after PR.Results: 18 studies were included in the meta-analysis. Admission rates per person-year were lower in the year following completion of PR. Results from 10 RCTs showed that the control groups had a higher overall rate of exacerbations than the PR groups (0.967, 95% confidence intervals (CIs) 0.669, 1.399 for control versus 0.615 95% CI 0.328, 1.155 for PR). Five studies compared admission numbers in the 12 months before and after PR, finding a significantly higher admission rate before (1.243, 95% CIs 0.661, 2.336) compared to after PR (0.472, 95% CIs 0.280, 0.794). The pooled result of three cohort studies found the reference group had a lower admission rate compared to the PR group (0.184, 95% CI 0.106, 0.317 for reference versus 0.282 95% CI 0.246, 0.323 for PR).Conclusions: Although results from RCTs suggested that PR reduces subsequent exacerbations, pooled results from the cohort studies did not favour PR, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standards of PR programmes.
Moore E, Newson R, Rothnie KJ, et al., 2016, Effects of pulmonary rehabilitation on exacerbation number and severity in people with Chronic Obstructive Pulmonary Disease (COPD), European Respiratory Society 2016, Publisher: European Respiratory Society, Pages: PA3775-PA3775, ISSN: 0903-1936
Background: Acute exacerbations of COPD are a major cause of morbidity and mortality and have a heavy burden on healthcare resources. Pulmonary rehabilitation (PR) has been shown to reduce hospital admissions and improve quality of life, but few studies have investigated the effect of PR on exacerbation rate using routinely collected health records.Methods: Primary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics (HES) on acute exacerbations were combined to determine the effects of PR on acute exacerbations of COPD one year before and after PR in patients who received PR compared to patients who did not.Findings: 108,042 patients were included in the analysis between 1st January 2004 and 31st March 2014. Of those, 38,952 (36%) were not eligible for PR. Of the 69,090 eligible; 6,436 (9.3%) were recorded a having received PR, 62,019 (89.8%) were not referred and 634 (0.9%) were referred but declined. When combining primary care events with HES events, people who received PR had a higher incidence rate (IR) of acute exacerbations (IR = 3.18 95% CI: 3.02, 3.35) compared to people who did not receive PR (IR = 3.04 95% CI: 2.88, 3.20).Conclusions: This study highlights that a high proportion of COPD patients eligible for PR in the UK are not being referred. In addition, poorer outcomes (defined as acute exacerbations) following PR suggest that either higher risk patients are being referred for PR, or PR as currently delivered is ineffective. Higher quality, standardised PR programmes should be encouraged to ensure outcomes from randomised controlled trials can be replicated in real life.
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