Journal of public health medicine最新文献

Background: Our aim was to describe the epidemiology of cutaneous malignant melanomas (CMMs) in males and females in the south east of England from 1960 to 1998. Birth cohort effects are important when describing the incidence of CMMs because fashions of dress affect whether different body sites are exposed to sunlight.

Methods: We calculated the age-standardized incidence of all CMMs for 5 year periods from 1960 to 1998 and the age-specific and age-standardized incidence of CMMs at different sites for 5 year periods from 1980 to 1998. We plotted age-specific incidence rates against period of diagnosis and birth cohort.

Results: The age-standardized incidence of CMMs increased from 1.3 to 7.1 per 100,000 person-years in males. Incidence increased from 2.4 to 7.8 per 100,000 person-years overall in females but levelled in the 1990s. Trunk CMMs had the highest incidence in males and the greatest increase in incidence. Lower limb CMMs had the highest incidence in females but their incidence decreased. The rate of increase of the age-specific incidence of trunk CMMs was greater for male birth cohorts before about 1945. The rate of increase of the incidence of lower limb CMMs was greater for female birth cohorts before about 1920.

Conclusions: If current trends continue, the age-standardized incidence of CMMs in females will remain stable. The increase in the age-standardized incidence of CMMs in males was driven by increases in the age-specific incidence of trunk CMMs in men who were born before about 1949. As they age, age-standardized incidence should level.

Background: Results from previous studies examining determinants of parental consultation for child mental health provide inconsistent evidence concerning socio-demographic predictors. The aim of this study is to identify the sociodemographic predictors of parental consultation for child psychological difficulties.

Method: An epidemiological cross-sectional analysis was carried out using a sample of 5,913 children aged between 4 and 15 years from the Health Survey for England. The Strengths and Difficulties Questionnaire (SDQ) was the measure of child psychological morbidity.

Results: Parents of children with psychological difficulties were less likely to seek a consultation if their child was a girl, as household income decreased or if the head of household came from manual social class. In contrast, parents were more likely to seek a consultation if they were in receipt of a benefit than if they were not in receipt of a benefit. Age of child and family type did not predict parental consultation.

Conclusions: The results of this analysis confirm that a substantial proportion of children with mental health difficulties in the general population (42 per cent) have not been seen by a professional, and these are likely to be girls and children in low-income families, indicating a significant unmet need for services across the nation. These results suggest that parents and health professionals should be made more aware of the symptoms of psychological problems in girls and that services need to be planned in a way that improves uptake by low-income parents.

Background: Maintenance of high participation rates in longitudinal studies is critical to their validity because of the possibility of bias associated with non-participation, which may differ between studies. This paper examines factors associated with participation status over time, by comparing the characteristics of non-attenders and attenders at a 20 year follow-up examination in a cardiovascular cohort study with an initial participation rate of 78 percent.

Methods: A baseline examination was carried out between 1978 and 1980 and subjects have been followed up through regular reviews of general practice records, postal questionnaires, and a clinical re-examination of survivors in 1998-2000. Data obtained by questionnaire in 1996 (Q96) and at baseline examination have been used to compare the characteristics of these recent non-attenders and attenders who remain in the cohort for further follow-up.

Results: The non-attendance rate of available survivors at re-examination was 23 per cent (n = 1313). Rates of non-attendance were highest in Scotland and lowest in Southern England. Non-attenders were older than attenders, more likely to smoke, and reported more disabling conditions and greater use of multiple medications at Q96, but recalled similar rates of diagnosed coronary heart disease. Marked differences in social factors were identified. Total mortality rates within 1 year of re-examination were over three times higher amongst non-attenders than attenders.

Conclusions: Non-attendance is related to health status, risk factor status and social circumstances and may affect some estimates of disease prevalence, but does not appearto have a major impact on the estimated prevalence of coronary heart disease. Information collected on non-attenders in longitudinal studies helps to estimate, adjust and minimize these effects.

Background: Mass media interventions can influence health care utilization but the effect of televised fictional accounts of illness upon national screening programmes is unknown. Our aim was to evaluate the impact of a Coronation Street story line, in which one of the characters died from cervical cancer, on the National Health Service (NHS) Cervical Screening Programme.

Methods: The study involved a retrospective analysis of information held on cervical screening databases ('Exeter' computer systems) of the nine Health Authorities constituting the Lancashire and Greater Manchester zones of the North West Region of the NHS. The number of cervical smears performed in the community, in women over 25 years of age, whose previous smear was normal and who were on routine recall, during a 6 month period that included the story line, was compared with those taken over the same period in the previous year. The proportions of smears classified by a screening interval of 'unscheduled', 'on time', 'overdue' or 'no previous smear' were compared.

Results: The number of smears performed increased from 65,714 in 2000 to 79,712 in 2001, an increase of 13,998 (21.3 percent; 95 per cent confidence interval (CI) 21.0-21.6 per cent) in the 19 weeks after the story line. The increase in the number of smears occurred in all categories of screening interval, with the largest increase seen in those attending 'on-time' (26 per cent).

Conclusions: We have demonstrated a large impact of a soap opera story line on the cervical screening programme although the benefit to health is not clear. Further research will determine the long-term effect of the story.

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

Background: The aim of the study was to develop guidelines for evaluating the quality of Internet-based information about alternative therapies.

Method: An expert committee drafted a set of guidelines for evaluating information relating to alternative therapies. The guidelines were subsequently refined by testing them using resources already included in the BIOME databases. The first 20 unique web sites about alternative therapies for cancer retrieved using a general search engine and a United Kingdom focused search engine were then evaluated using the refined guidelines. Those undertaking the evaluations also completed a questionnaire relating to the face and content validity of the guidelines. The participants in the implementation stage were six content providers. Content providers identify, evaluate and describe resources for inclusion in the BIOME databases.

Results: Only one web site out of 20 was selected by all six content providers for inclusion in the BIOME databases according to the alternative therapies guidelines. All content providers were in agreement regarding the exclusion of nine sites, but there were discrepancies regarding the remaining 10 resources. There was general agreement that the guidelines were easy to understand and that all points raised were necessary. However, there were differences of opinion regarding whether all issues were covered, whether the guidelines allowed the selection of only the highest quality resources, and whether the guidelines were applicable to a wide range of Internet-based resources about alternative therapies.

Conclusions: The levels of inconsistencies in the results indicate the need for the further development of the BIOME guidelines for selecting information about alternative therapies.

Background: We aimed to determine the views of Directors of Public Health about the Health Technology Appraisal Programme of the National Institute for Clinical Excellence (NICE) before the move to strategic health authorities and primary care trusts in April 2002.

Method: In December 2001 we sent a questionnaire asking about the work programme, products, decision-making, general approach, resource allocation and success of NICE to all Directors of Public Health in England and Wales. Ninety-two of 100 responded.

Results: Three-quarters or more agreed that NICE has covered a number of priority and controversial areas, produced good-quality health technology appraisals, well-presented reports and readable guidance in a consistent format, that it has raised the profile of clinical effectiveness, provided a focus for debate about health technology, and succeeded in making the National Health Service (NHS) set aside resources for approved technologies. A similar proportion, however, also agreed that guidance was not timely, did not address 'whole systems' and made some disappointing recommendations, and that decision-making was not influenced enough by the needs of the NHS. They considered that NICE did not address implementation, decide between competing technologies or help the service prioritization debate, and that guidance sent unrealistic signals about affordability to patients and politicians and caused difficulty for the implementation of other technologies locally.

Conclusions: A majority of Directors are positive about NICE's role of providing high-quality appraisal and central guidance but negative about its influence on local priority setting. Major concerns remain about the affordability of competing demands, whether this is NICE's responsibility or not.