Pub Date : 2024-11-09DOI: 10.1016/j.puhip.2024.100557
Peter M. Barrett , Fionn P. Daly , Mengyang Zhang , Aislinn O'Reilly , Patricia Heckmann , Paula Tierney , Deirdre Murray , Maeve Mullooly , Kathleen Bennett
Objectives
The COVID-19 pandemic had considerable implications for cancer related care. This study aimed to examine its impact on the dispensing of systemic anti-cancer therapy (SACT) in Ireland.
Study design
A repeated cross-sectional design was used which involved a quasi-experimental interrupted time series analysis (ITSA), and autoregressive integrated moving average (ARIMA) models.
Methods
This nationally representative study utilised monthly pharmacy claims (i.e. dispensing) data from community and hospital schemes. Dispensed items among individuals prescribed any SACT from January 2019 to April 2021 were included.
Results
During the study period, 641,273 SACT items were dispensed, including 57,199 chemotherapeutic agents (8.9 %), 15,970 immunotherapeutic agents (2.5 %), 87,813 targeted therapies (13.7 %), and 480,291 (74.9 %) endocrine therapies. There were on average 3.3 and 4.1 fewer immunotherapy and targeted therapy agents, respectively, dispensed per 100,000 population per month post-March 2020 (vs. expected), compared to the level prior to March 2020. For endocrine therapy, there was a significant slowing of the trend post-March 2020 compared to the pre-pandemic period (slope change = −1.72, 95 % CI -2.9 to −0.5; p<0.01).
Conclusion
There was a significant level decrease in the dispensing of immunotherapy and targeted therapy during the first year of the pandemic, and a slowing of the trend for endocrine therapies. However, no differences in the dispensing of other SACT were observed.
{"title":"The impact of the COVID-19 pandemic on the dispensing of systemic anti-cancer therapy (SACT) in Ireland: A population based study","authors":"Peter M. Barrett , Fionn P. Daly , Mengyang Zhang , Aislinn O'Reilly , Patricia Heckmann , Paula Tierney , Deirdre Murray , Maeve Mullooly , Kathleen Bennett","doi":"10.1016/j.puhip.2024.100557","DOIUrl":"10.1016/j.puhip.2024.100557","url":null,"abstract":"<div><h3>Objectives</h3><div>The COVID-19 pandemic had considerable implications for cancer related care. This study aimed to examine its impact on the dispensing of systemic anti-cancer therapy (SACT) in Ireland.</div></div><div><h3>Study design</h3><div>A repeated cross-sectional design was used which involved a quasi-experimental interrupted time series analysis (ITSA), and autoregressive integrated moving average (ARIMA) models.</div></div><div><h3>Methods</h3><div>This nationally representative study utilised monthly pharmacy claims (i.e. dispensing) data from community and hospital schemes. Dispensed items among individuals prescribed any SACT from January 2019 to April 2021 were included.</div></div><div><h3>Results</h3><div>During the study period, 641,273 SACT items were dispensed, including 57,199 chemotherapeutic agents (8.9 %), 15,970 immunotherapeutic agents (2.5 %), 87,813 targeted therapies (13.7 %), and 480,291 (74.9 %) endocrine therapies. There were on average 3.3 and 4.1 fewer immunotherapy and targeted therapy agents, respectively, dispensed per 100,000 population per month post-March 2020 (vs. expected), compared to the level prior to March 2020. For endocrine therapy, there was a significant slowing of the trend post-March 2020 compared to the pre-pandemic period (slope change = −1.72, 95 % CI -2.9 to −0.5; p<0.01).</div></div><div><h3>Conclusion</h3><div>There was a significant level decrease in the dispensing of immunotherapy and targeted therapy during the first year of the pandemic, and a slowing of the trend for endocrine therapies. However, no differences in the dispensing of other SACT were observed.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100557"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.puhip.2024.100556
B.K. Datta , A. Tiwari , L. Glenn
Objectives
Child marriage prematurely forces girls (<18 years of age) to perform adult roles prior to physical and psychological maturity. Such precocious transitions to young adulthood can have consequences on their long-term health, however, limited work has examined such relationships to date. As such, this study examines whether child marriage is associated with the risk of having hyperglycemia, or high blood glucose, in adulthood.
Study design
Observational study using repeated cross-sectional data.
Methods
Using data from the 2015-16 and 2019-21 waves of the India National Family Health Survey, we matched 432,080 and 418,409 women, aged 20–49 years, by birth year and month to create birth cohorts. Fitting multivariable binomial and multinomial logistic models, we compared the odds of having hyperglycemia across groups by marriage age (i.e., before or after age 18 years) within respective birth cohorts.
Results
We found that the adjusted odds of having high blood glucose among women married as children were 1.12 (95 % CI: 1.07–1.16) times that of their peers married as adults in the full-sample. The adjusted relative risks of having blood glucose levels higher than normal but lower than diabetic and diabetic ranges were 1.09 (95 % CI: 1.04–1.14) and 1.23 (95 % CI: 1.15–1.31), respectively, in comparison to blood glucose within normal range. These results were persistent across sub-groups of different birth cohorts.
Conclusion
Our findings suggest that child marriage was associated with higher risk of having high blood glucose in women, later in life.
{"title":"Association between child marriage and high blood glucose level in women: A birth cohort analysis","authors":"B.K. Datta , A. Tiwari , L. Glenn","doi":"10.1016/j.puhip.2024.100556","DOIUrl":"10.1016/j.puhip.2024.100556","url":null,"abstract":"<div><h3>Objectives</h3><div>Child marriage prematurely forces girls (<18 years of age) to perform adult roles prior to physical and psychological maturity. Such precocious transitions to young adulthood can have consequences on their long-term health, however, limited work has examined such relationships to date. As such, this study examines whether child marriage is associated with the risk of having hyperglycemia, or high blood glucose, in adulthood.</div></div><div><h3>Study design</h3><div>Observational study using repeated cross-sectional data.</div></div><div><h3>Methods</h3><div>Using data from the 2015-16 and 2019-21 waves of the India National Family Health Survey, we matched 432,080 and 418,409 women, aged 20–49 years, by birth year and month to create birth cohorts. Fitting multivariable binomial and multinomial logistic models, we compared the odds of having hyperglycemia across groups by marriage age (i.e., before or after age 18 years) within respective birth cohorts.</div></div><div><h3>Results</h3><div>We found that the adjusted odds of having high blood glucose among women married as children were 1.12 (95 % CI: 1.07–1.16) times that of their peers married as adults in the full-sample. The adjusted relative risks of having blood glucose levels higher than normal but lower than diabetic and diabetic ranges were 1.09 (95 % CI: 1.04–1.14) and 1.23 (95 % CI: 1.15–1.31), respectively, in comparison to blood glucose within normal range. These results were persistent across sub-groups of different birth cohorts.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that child marriage was associated with higher risk of having high blood glucose in women, later in life.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100556"},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.puhip.2024.100551
J. Lecouturier , Michael P. Kelly , Falko F. Sniehotta
Background
UK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local inequalities in relation to uptake of the Covid-19 vaccination with a view to generalising insights to building back fairer after the pandemic and into the future.
Study design
Qualitative.
Method
We conducted in-depth on-line interviews with Directors of Public Health or their representatives from 21 English local authorities covering a total population of over 8 million people. Data were analysed thematically.
Results
Accessing the requisite (and accurate) data, engaging with communities, and working with National Health Service (NHS) organisations presented challenges in delivering initiatives to improve vaccine uptake, particularly for disadvantaged groups. LAPHT's assets beneficial to the programme - in-depth knowledge and experience of their communities and locality - were not considered in the national vaccination programme. Community engagement and relationships with local NHS featured heavily in the majority of LAPHTs responses to improving vaccine uptake rates.
Conclusions
Incorporating local public health infrastructure, expertise and existing relationships into national vaccination planning during epidemics or pandemics is crucial. Community engagement and good relationships with NHS staff help to reach and serve disadvantaged populations. How these can be developed and maintained in the longer term without future investment was a concern. Future research should explore the design and implementation of PH and NHS joint service delivery models to tackle health inequalities, informed by experiences of the Covid-19 vaccination programme and with input from community partners.
{"title":"Reaching national Covid-19 vaccination targets whilst decreasing inequalities in vaccine uptake: Public health teams' challenges in supporting disadvantaged populations","authors":"J. Lecouturier , Michael P. Kelly , Falko F. Sniehotta","doi":"10.1016/j.puhip.2024.100551","DOIUrl":"10.1016/j.puhip.2024.100551","url":null,"abstract":"<div><h3>Background</h3><div>UK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local inequalities in relation to uptake of the Covid-19 vaccination with a view to generalising insights to building back fairer after the pandemic and into the future.</div></div><div><h3>Study design</h3><div>Qualitative.</div></div><div><h3>Method</h3><div>We conducted in-depth on-line interviews with Directors of Public Health or their representatives from 21 English local authorities covering a total population of over 8 million people. Data were analysed thematically.</div></div><div><h3>Results</h3><div>Accessing the requisite (and accurate) data, engaging with communities, and working with National Health Service (NHS) organisations presented challenges in delivering initiatives to improve vaccine uptake, particularly for disadvantaged groups. LAPHT's assets beneficial to the programme - in-depth knowledge and experience of their communities and locality - were not considered in the national vaccination programme. Community engagement and relationships with local NHS featured heavily in the majority of LAPHTs responses to improving vaccine uptake rates.</div></div><div><h3>Conclusions</h3><div>Incorporating local public health infrastructure, expertise and existing relationships into national vaccination planning during epidemics or pandemics is crucial. Community engagement and good relationships with NHS staff help to reach and serve disadvantaged populations. How these can be developed and maintained in the longer term without future investment was a concern. Future research should explore the design and implementation of PH and NHS joint service delivery models to tackle health inequalities, informed by experiences of the Covid-19 vaccination programme and with input from community partners.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100551"},"PeriodicalIF":2.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chlamydia Trachomatis (CT) is the most sexually transmitted infection in France. This study aimed to assess the feasibility of systematic screening for CT among people attending a preventive health examination in Health Examination Centres (HECs) and to compare positive CT cases according to deprivation.
Design
A cross-sectional multicentre study in thirteen HECs in France in January 2018.
Methods
Self-sampling CT screening was proposed among 18–25 years women and 18–30 years men, who were sexually active and without recent CT treatment. Related data and referred specimens were collected among attendees for the study, including deprivation and health status. CT positivity was estimated by genders. We explored association between CT infection and deprivation by univariate and multivariate modelling.
Results
The CT screening was proposed to 1701 eligible young people. 90.1 % [88.6–91.5] accepted and participated with 43.6 % being women, 54.3 % being deprived people. 75.4 % [72.1–78.6] screened women performed self-taken vaginal swabs and others took urinary tests. Screening was conducted in 1486 people. Overall prevalence of CT infection was 4.7 % [3.7%–5.9 %], significantly higher for women than men (6.4 % vs 3.4 %, p=0.009). Among women, being deprived increased the likelihood of CT positivity (aOR 4.95; 95 % CI 2.02 to 12.00) more than it did for men.
Conclusions
Individual deprivation was significantly associated with having a CT infection among women. The feasibility of CT screening in HECs was demonstrated, with a high acceptance, and led to the implementation of CT screening in all HECs. Promoting access to CT screening to deprived population might contribute to reduce social inequalities in health.
{"title":"Young, deprived women are more at risk of testing positive for Chlamydia trachomatis: Results from a cross-sectional multicentre study in French health examination centres","authors":"Emilie Labbe-Lobertreau , Mathieu Oriol , Luc Goethals , Isabelle Vincent , Emmanuel Amsallem","doi":"10.1016/j.puhip.2024.100554","DOIUrl":"10.1016/j.puhip.2024.100554","url":null,"abstract":"<div><h3>Objectives</h3><div>Chlamydia Trachomatis (CT) is the most sexually transmitted infection in France. This study aimed to assess the feasibility of systematic screening for CT among people attending a preventive health examination in Health Examination Centres (HECs) and to compare positive CT cases according to deprivation.</div></div><div><h3>Design</h3><div>A cross-sectional multicentre study in thirteen HECs in France in January 2018.</div></div><div><h3>Methods</h3><div>Self-sampling CT screening was proposed among 18–25 years women and 18–30 years men, who were sexually active and without recent CT treatment. Related data and referred specimens were collected among attendees for the study, including deprivation and health status. CT positivity was estimated by genders. We explored association between CT infection and deprivation by univariate and multivariate modelling.</div></div><div><h3>Results</h3><div>The CT screening was proposed to 1701 eligible young people. 90.1 % [88.6–91.5] accepted and participated with 43.6 % being women, 54.3 % being deprived people. 75.4 % [72.1–78.6] screened women performed self-taken vaginal swabs and others took urinary tests. Screening was conducted in 1486 people. Overall prevalence of CT infection was 4.7 % [3.7%–5.9 %], significantly higher for women than men (6.4 % vs 3.4 %, <em>p=0.009</em>). Among women, being deprived increased the likelihood of CT positivity (aOR 4.95; 95 % CI 2.02 to 12.00) more than it did for men.</div></div><div><h3>Conclusions</h3><div>Individual deprivation was significantly associated with having a CT infection among women. The feasibility of CT screening in HECs was demonstrated, with a high acceptance, and led to the implementation of CT screening in all HECs. Promoting access to CT screening to deprived population might contribute to reduce social inequalities in health.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100554"},"PeriodicalIF":2.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.puhip.2024.100552
Catherine Jones , Thomas Keegan , Andy Knox , Alison Birtle , Jessica A. Mendes , Kelly Heys , Peter M. Atkinson , Luigi Sedda
Objectives
This study aims to analyse the geographical co-occurrence of cancers and their individual and shared risk factors in a highly deprived area of the North West of England to aid the identification of potential interventions.
Study design
An ecological study design was employed and applied at postcode sector level in the Morecambe Bay region.
Methods
A novel spatial joint modelling framework designed to account for large frequencies of left-censored cancer data was employed. Nine cancer types (breast, colorectal, gynaecology, haematology, head and neck, lung, skin, upper gastrointestinal, urology) alongside demographic, behavioural factors and socio-economic variables were included in the model. Explanatory factors were selected by employing an accelerated failure model with lognormal distribution. Post-processing included principal components analysis and hierarchical clustering to delineate geographic areas with similar spatial risk patterns of different cancer types.
Results
15,506 cancers were diagnosed from 2017 to 2022, with the highest incidence in skin, breast and urology cancers. Factors such as age, ethnicity, frailty and comorbidities were associated with cancer risk for most of the cancer types. A positive geographical association was found mostly between the colorectal, haematology, upper GI, urology and head and neck cancer types. That is, these cancers had their largest risk in the same areas, similarly to their lowest risk values. The spatial distribution of the risk and cumulative risk of the cancer types revealed regional variations, with five clusters identified based on cancer type risk, demographic and socio-economic characteristics. Rural areas were the least affected by cancer and the urban area of Barrow-in-Furness was the area with the highest cancer risk, three times greater than the risk in the surrounding rural areas.
Conclusions
This study emphasizes the utility of joint disease mapping by geographically identifying common or shared factors that, if targeted, could lead to reduced risk of multiple cancers simultaneously. The findings suggest the need for tailored public health interventions, considering specific risk factors and socio-economic disparities. Policymakers can utilize the spatial patterns identified to allocate resources effectively and implement targeted cancer prevention programmes.
{"title":"Syndemic geographic patterns of cancer risk in a health-deprived area of England","authors":"Catherine Jones , Thomas Keegan , Andy Knox , Alison Birtle , Jessica A. Mendes , Kelly Heys , Peter M. Atkinson , Luigi Sedda","doi":"10.1016/j.puhip.2024.100552","DOIUrl":"10.1016/j.puhip.2024.100552","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to analyse the geographical co-occurrence of cancers and their individual and shared risk factors in a highly deprived area of the North West of England to aid the identification of potential interventions.</div></div><div><h3>Study design</h3><div>An ecological study design was employed and applied at postcode sector level in the Morecambe Bay region.</div></div><div><h3>Methods</h3><div>A novel spatial joint modelling framework designed to account for large frequencies of left-censored cancer data was employed. Nine cancer types (breast, colorectal, gynaecology, haematology, head and neck, lung, skin, upper gastrointestinal, urology) alongside demographic, behavioural factors and socio-economic variables were included in the model. Explanatory factors were selected by employing an accelerated failure model with lognormal distribution. Post-processing included principal components analysis and hierarchical clustering to delineate geographic areas with similar spatial risk patterns of different cancer types.</div></div><div><h3>Results</h3><div>15,506 cancers were diagnosed from 2017 to 2022, with the highest incidence in skin, breast and urology cancers. Factors such as age, ethnicity, frailty and comorbidities were associated with cancer risk for most of the cancer types. A positive geographical association was found mostly between the colorectal, haematology, upper GI, urology and head and neck cancer types. That is, these cancers had their largest risk in the same areas, similarly to their lowest risk values. The spatial distribution of the risk and cumulative risk of the cancer types revealed regional variations, with five clusters identified based on cancer type risk, demographic and socio-economic characteristics. Rural areas were the least affected by cancer and the urban area of Barrow-in-Furness was the area with the highest cancer risk, three times greater than the risk in the surrounding rural areas.</div></div><div><h3>Conclusions</h3><div>This study emphasizes the utility of joint disease mapping by geographically identifying common or shared factors that, if targeted, could lead to reduced risk of multiple cancers simultaneously. The findings suggest the need for tailored public health interventions, considering specific risk factors and socio-economic disparities. Policymakers can utilize the spatial patterns identified to allocate resources effectively and implement targeted cancer prevention programmes.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100552"},"PeriodicalIF":2.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.puhip.2024.100555
Paul Crawshaw , Joanne Gray , Catherine Haighton , Scott Lloyd
Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities. Regionally, the health of local labour markets, a phenomenon shaped by macro, national and global economic forces, is a powerful determinant of opportunities to access and remain in work. Simultaneously, health status impacts significantly on ability to participate in paid employment. Absence from the labour market is both a cause and symptom of health inequalities.
Economic inactivity, where people are both not participating in the labour market, or actively seeking or available for work, is strongly correlated with poor health. In the UK, over one third of the economically inactive experience long-term health problems. The implications for health inequalities, as both cause and symptom are clear. Participation in paid work, where appropriate, can be beneficial both economically and for health and wellbeing. Continued absence from the labour market is directly correlated with ill health. The determinants of health-related economic inactivity are complex and can only be understood using ecological models of public health. This presents significant challenges for politicians and policymakers alike concerned with reducing economic inactivity, delivering economic growth and redressing regional disparities.
{"title":"Health inequalities and health-related economic inactivity: Why good work needs good health","authors":"Paul Crawshaw , Joanne Gray , Catherine Haighton , Scott Lloyd","doi":"10.1016/j.puhip.2024.100555","DOIUrl":"10.1016/j.puhip.2024.100555","url":null,"abstract":"<div><div>Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities. Regionally, the health of local labour markets, a phenomenon shaped by macro, national and global economic forces, is a powerful determinant of opportunities to access and remain in work. Simultaneously, health status impacts significantly on ability to participate in paid employment. Absence from the labour market is both a <em>cause</em> and <em>symptom</em> of health inequalities.</div><div>Economic inactivity, where people are both not participating in the labour market, or actively seeking or available for work, is strongly correlated with poor health. In the UK, over one third of the economically inactive experience long-term health problems. The implications for health inequalities, as both cause and symptom are clear. Participation in paid work, where appropriate, can be beneficial both economically and for health and wellbeing. Continued absence from the labour market is directly correlated with ill health. The determinants of health-related economic inactivity are complex and can only be understood using ecological models of public health. This presents significant challenges for politicians and policymakers alike concerned with reducing economic inactivity, delivering economic growth and redressing regional disparities.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100555"},"PeriodicalIF":2.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.puhip.2024.100550
Lior Rennert , Fatih Gezer , Iromi Jayawardena , Kerry A. Howard , Kevin J. Bennett , Alain H. Litwin , Kerry K. Sease
Objectives
Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies.
Study design
The study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022.
Methods
Prisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models.
Results
The MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare.
Conclusions
The high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.
{"title":"Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study","authors":"Lior Rennert , Fatih Gezer , Iromi Jayawardena , Kerry A. Howard , Kevin J. Bennett , Alain H. Litwin , Kerry K. Sease","doi":"10.1016/j.puhip.2024.100550","DOIUrl":"10.1016/j.puhip.2024.100550","url":null,"abstract":"<div><h3>Objectives</h3><div>Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies.</div></div><div><h3>Study design</h3><div>The study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022.</div></div><div><h3>Methods</h3><div>Prisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models.</div></div><div><h3>Results</h3><div>The MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare.</div></div><div><h3>Conclusions</h3><div>The high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100550"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.puhip.2024.100549
J. Howkins , Daniela N. Schmidt , James Thomas , Robert Hayward , Y.T. Eunice Lo , Jeffrey Neal , James Lewis , Elspeth Carruthers , Samuel Coleborn , Virginia Murray , Isabel Oliver
Background
Local authorities have a crucial role in building community resilience to the health effects of a changing climate. Support in achieving local action can be provided through improving available public health intelligence to inform decision making. We aimed to co-develop with a local authority a tool mapping vulnerability to climate related hazards.
Methods
We conducted a feasibility study, exploring through stakeholder engagement local priorities and levers for action in adaptation that could be informed by provision of increased intelligence. This informed co-development of a proof-of-concept tool.
Results
Stakeholders reported needs in better understanding the intersection between vulnerability and hazard to facilitate partnership working, decision making, and targeting of interventions. We developed a mapping tool, using nationally available data, overlaying a vulnerability index with hazard (heat and flooding) exposure.
Conclusions
Mapping tools are feasible methods by which public health intelligence to support climate change adaptation planning can be shared. Barriers to action may result from the complexity of vulnerability, concerns of unintended consequences, and resource constraints. Co-development with local expertise is necessary to ensure that outputs add value to local response. This tool will now be piloted to gather feedback on useability, usefulness, and potential improvements.
{"title":"Mapping vulnerability to climate-related hazards to inform local authority action in adaptation: A feasibility study","authors":"J. Howkins , Daniela N. Schmidt , James Thomas , Robert Hayward , Y.T. Eunice Lo , Jeffrey Neal , James Lewis , Elspeth Carruthers , Samuel Coleborn , Virginia Murray , Isabel Oliver","doi":"10.1016/j.puhip.2024.100549","DOIUrl":"10.1016/j.puhip.2024.100549","url":null,"abstract":"<div><h3>Background</h3><div>Local authorities have a crucial role in building community resilience to the health effects of a changing climate. Support in achieving local action can be provided through improving available public health intelligence to inform decision making. We aimed to co-develop with a local authority a tool mapping vulnerability to climate related hazards.</div></div><div><h3>Methods</h3><div>We conducted a feasibility study, exploring through stakeholder engagement local priorities and levers for action in adaptation that could be informed by provision of increased intelligence. This informed co-development of a proof-of-concept tool.</div></div><div><h3>Results</h3><div>Stakeholders reported needs in better understanding the intersection between vulnerability and hazard to facilitate partnership working, decision making, and targeting of interventions. We developed a mapping tool, using nationally available data, overlaying a vulnerability index with hazard (heat and flooding) exposure.</div></div><div><h3>Conclusions</h3><div>Mapping tools are feasible methods by which public health intelligence to support climate change adaptation planning can be shared. Barriers to action may result from the complexity of vulnerability, concerns of unintended consequences, and resource constraints. Co-development with local expertise is necessary to ensure that outputs add value to local response. This tool will now be piloted to gather feedback on useability, usefulness, and potential improvements.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100549"},"PeriodicalIF":2.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.puhip.2024.100548
Shriti Pattani , Marie Line El Asmar , Manisha Karki , Eva Riboli Sasco , Lara Shemtob , Kabir Varghese , Austen El-Osta
Background
The integration of work coaches (WCs) and disability employment advisors (DEAs) into General Practitioner (GP) practices in the UK aims to address the interplay between health and employment by facilitating access to employment support, especially to people with disabilities and health conditions affecting their ability to work. This study seeks to explore the perspectives and perceptions of WCs, DEAs and GPs regarding the benefits and challenges of embedding WCs and DEAs in GP practices.
Methods
Data was collected between May and July 2023 through semi-structured interviews with four GPs, four WCs and four DEAs working in NHS GP practices. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Thematic Framework method. Emergent themes were pre-structured and classified as perceived benefits, barriers and challenges or drivers and strategies.
Results
The integration of WCs & DEAs within GP practices was perceived by respondents as fostering a direct collaboration between professionals as well as a greater openness of patients which benefited patients, WCs/DEAs and GPs. While all respondents emphasised the various benefits, they also identified several barriers and challenges. The implementation stage was perceived as particularly challenging, especially by WCs and DEAs, whereas the lack of human, financial and logistical resources hindered the service beyond this stage. Several strategies and drivers to support the service were identified, including the importance of receiving support from all professionals involved as well as making the service visible to both healthcare professionals and patients.
Conclusion
Embedding WCs and DEAs in GP practices emerges as a promising approach which can benefit patients, GPs and WCs/DEAs. Exploring patients' perspectives directly is crucial to fully assess this type of service and identify any additional challenges and benefits.
{"title":"Embedding work coaches in GP practices: Findings from an interview-based study in the UK","authors":"Shriti Pattani , Marie Line El Asmar , Manisha Karki , Eva Riboli Sasco , Lara Shemtob , Kabir Varghese , Austen El-Osta","doi":"10.1016/j.puhip.2024.100548","DOIUrl":"10.1016/j.puhip.2024.100548","url":null,"abstract":"<div><h3>Background</h3><div>The integration of work coaches (WCs) and disability employment advisors (DEAs) into General Practitioner (GP) practices in the UK aims to address the interplay between health and employment by facilitating access to employment support, especially to people with disabilities and health conditions affecting their ability to work. This study seeks to explore the perspectives and perceptions of WCs, DEAs and GPs regarding the benefits and challenges of embedding WCs and DEAs in GP practices.</div></div><div><h3>Methods</h3><div>Data was collected between May and July 2023 through semi-structured interviews with four GPs, four WCs and four DEAs working in NHS GP practices. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Thematic Framework method. Emergent themes were pre-structured and classified as perceived benefits, barriers and challenges or drivers and strategies.</div></div><div><h3>Results</h3><div>The integration of WCs & DEAs within GP practices was perceived by respondents as fostering a direct collaboration between professionals as well as a greater openness of patients which benefited patients, WCs/DEAs and GPs. While all respondents emphasised the various benefits, they also identified several barriers and challenges. The implementation stage was perceived as particularly challenging, especially by WCs and DEAs, whereas the lack of human, financial and logistical resources hindered the service beyond this stage. Several strategies and drivers to support the service were identified, including the importance of receiving support from all professionals involved as well as making the service visible to both healthcare professionals and patients.</div></div><div><h3>Conclusion</h3><div>Embedding WCs and DEAs in GP practices emerges as a promising approach which can benefit patients, GPs and WCs/DEAs. Exploring patients' perspectives directly is crucial to fully assess this type of service and identify any additional challenges and benefits.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100548"},"PeriodicalIF":2.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/j.puhip.2024.100543
A. Barnes , F. Phillips , K. Pickett , A.J. Haider , J. Robinson-Joyce , S. Ahmed
Objective
To rapidly identify and summarise evidence on key factors that affect access to support for minoritised informal adult carers which could be addressed at the level of local government policy-making.
Study design
Rapid evidence review.
Methods
A rapid umbrella review was undertaken of systematic reviews of qualitative, quantitative and/or mixed method studies. Systematic reviews were identified through database searches (Medline, Cochrane, Proquest), key author searching, referrals by experts (n = 2) of key reviews, and citation and reference checking of identified reviews in September–October 2023. Systematic review evidence was supplemented with grey literature identified by practitioners (n = 2) as locally-relevant. Data was extracted directly into a table and findings synthesised narratively by theme.
Results
Many factors were identified as affecting access to support for minoritised unpaid adult carers, including: inattention to socio-cultural diversity; issues of representation, racism and discrimination; and socio-economic inequality. Factors were themed around ten areas for local action, including: the importance of recognising intersectional disadvantage and diversity; ensuring support is socio-culturally appropriate; paying attention to gendered hierarchies in service design; identifying and ‘designing out’ racism and discrimination; addressing exclusions that minoritised carers with additional communication needs face; mitigating socio-economic inequality; and taking a ‘whole system’ approach that improves integration, routine data collection and support service evaluation.
Conclusions
We identified ten potential ways in which inequalities in support for minoritised unpaid adult carers could be addressed locally. Although the existing evidence base is limited, these ten areas could usefully be targeted for further investigation in research and within local policy development.
{"title":"Rapid review: Ten ways to improve support for minoritised informal adult carers at local government policy level to redress inequality","authors":"A. Barnes , F. Phillips , K. Pickett , A.J. Haider , J. Robinson-Joyce , S. Ahmed","doi":"10.1016/j.puhip.2024.100543","DOIUrl":"10.1016/j.puhip.2024.100543","url":null,"abstract":"<div><h3>Objective</h3><p>To rapidly identify and summarise evidence on key factors that affect access to support for minoritised informal adult carers which could be addressed at the level of local government policy-making.</p></div><div><h3>Study design</h3><p>Rapid evidence review.</p></div><div><h3>Methods</h3><p>A rapid umbrella review was undertaken of systematic reviews of qualitative, quantitative and/or mixed method studies. Systematic reviews were identified through database searches (Medline, Cochrane, Proquest), key author searching, referrals by experts (n = 2) of key reviews, and citation and reference checking of identified reviews in September–October 2023. Systematic review evidence was supplemented with grey literature identified by practitioners (n = 2) as locally-relevant. Data was extracted directly into a table and findings synthesised narratively by theme.</p></div><div><h3>Results</h3><p>Many factors were identified as affecting access to support for minoritised unpaid adult carers, including: inattention to socio-cultural diversity; issues of representation, racism and discrimination; and socio-economic inequality. Factors were themed around ten areas for local action, including: the importance of recognising intersectional disadvantage and diversity; ensuring support is socio-culturally appropriate; paying attention to gendered hierarchies in service design; identifying and ‘designing out’ racism and discrimination; addressing exclusions that minoritised carers with additional communication needs face; mitigating socio-economic inequality; and taking a ‘whole system’ approach that improves integration, routine data collection and support service evaluation.</p></div><div><h3>Conclusions</h3><p>We identified ten potential ways in which inequalities in support for minoritised unpaid adult carers could be addressed locally. Although the existing evidence base is limited, these ten areas could usefully be targeted for further investigation in research and within local policy development.</p></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"8 ","pages":"Article 100543"},"PeriodicalIF":2.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666535224000806/pdfft?md5=646a799c332571fe4cca2e552a03f779&pid=1-s2.0-S2666535224000806-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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