Journal of public health medicine最新文献

Public health practitioners are often suspicious of colleagues who work with the pharmaceutical industry. But, by analogy with the legal system, public good flows from allowing commercial interests to present their case as strongly as possible within rules set by the government or National Health Service. In court, both parties work within an agreed framework, but each party presents only one side of the argument. Arguing the commercial case balances the drive for innovation against the inertia of the NHS.

Background: Little is known about risk perception amongst parents who have their children immunized, as opposed to those who do not. Our objective was to assess their vaccine risk perception and thereby to identify strategies to prevent further deterioration in uptake.

Methods: An in-depth interview study was conducted with parents in two nurseries, one urban and one rural in Norfolk, together with a pilot study. All their children were fully immunized. Topics related to parents' vaccine risk perceptions.

Results: Certain known risk characteristics were attributable to the measles, mumps and rubella vaccine, including feeling of dread, lack of control and doubt in scientific knowledge. Furthermore, this study re-emphasizes that parents lack trust in government agencies and may have doubts in the medical profession as the 'managers' of vaccine risk.

Conclusions: Results highlighted an urgent need to address concerns amongst parents who immunize, to prevent them changing their practice in the face of further vaccine controversies.

Background: A descriptive study was conducted in Tehran, Iran, to investigate the beliefs of Muslim women and their practices regarding screening modalities of breast cancer.

Methods: A questionnaire was specially designed and validated to collect data and was completed by 410 Muslim women.

Results: A vast majority of women (90 per cent) said that breast self-examination is not against their religious beliefs. With regard to clinical breast examination, although 58 per cent preferred to be examined by a female physician, 47 per cent said that clinical breast examination by a male physician is not against their Islamic beliefs. However, only 6 per cent of respondents performed breast self-examination on a regular basis (monthly).

Conclusions: The study findings suggest that most Muslim women do not perceive breast self-examination as being against their Islamic beliefs and that they believe clinical breast examination by a male physician does not interfere with their religious beliefs.

This paper describes the successful implementation of universal antenatal screening for HIV and hepatitis B in Southampton and South West Hampshire Health Authority. This was achieved through formation of a multi-disciplinary planning group of clinicians and managers from local trusts. The approach taken in implementing screening is described, key elements of this being the appointment of screening co-ordinators and consultation with local midwives to ensure their training needs were addressed. Lessons for future work are discussed.

Background: Low incomes may not provide the minimum requirements for healthy living. We evaluated experiences of food insecurity in relation to income in inner London.

Methods: Subjects attending 10 general medical practices completed a short self-administered questionnaire, including the short form Household Food Security Scale and a short food frequency questionnaire.

Results: Responses were obtained from 431/495 (87 per cent) subjects. Overall 87 (20 per cent) of subjects were classified as food insecure. Food insecurity was negatively associated with household income (p = 0.004). University-educated subjects (8 per cent) were less often food insecure than all others (26 per cent). Subjects who were food insecure were less likely to report eating fruit daily (food secure 48 per cent, food insecure 33 per cent, p = 0.017) or vegetables or salads daily (food secure 56 per cent, food insecure 34 per cent, p = 0.002).

Conclusions: Experiences of food insecurity may be common in households with incomes at the level of the UK national minimum wage or lower.

Background: Approximately 110,000 people in the United Kingdom are affected with familial hypercholesterolaemia (FH). At least 75 per cent are undiagnosed. Treatment with statins is effective but effective primary prevention requires early diagnosis. The best strategy to achieve this is unclear. This paper compares the costs and benefits over a 10 year period of two strategies found in our previous modelling: population screening of 16-year-olds or tracing family members of affected patients.

Methods: Computer modelling of time-limited data was conducted. The number available for screening and the potential new cases in England and Wales aged 16-54 years were estimated. The costs (of screening and treatment) and benefits (deaths averted) that might be accrued over 10 years were assessed.

Results: Screening 16-year-olds results in 470 new diagnoses, and over 10 subsequent years averts 11.7 deaths at a cost of 6,176,648 pounds sterling, giving a cost per case identified and treated of 13,141 pounds sterling (including a 10 year drug cost of 1,584,918 pounds sterling). By contrast, screening first-degree relatives of known uases results in 13,248 new diagnoses, 560 deaths averted over 10 years, at a cost of 46,430,681 pounds sterling giving a cost per case identified and treated of 3,505 pounds sterling (including 10 year drug cost of 44,645,760 pounds sterling). The cost per death averted would be 3,187 pounds sterling.

Conclusions: Although the two approaches appear similar in cost-effectiveness over a lifetime, the shorter-term (10 year) cost-effectiveness clearly favours family tracing. This represents good value for money compared with common medical interventions, and suggests that pilot FH family tracing programmes should be conducted.

Background: The aim of the study was to investigate the relative effectiveness of four strategies in detecting and preventing tuberculosis: contact tracing of smear-positive pulmonary disease, of smear-negative pulmonary disease and of non-pulmonary disease, and screening new entrants.

Methods: An analysis of patient records and a TB database was carried out for an NHS Trust-based tuberculosis service in a socio-economically deprived area. Subjects were contacts of all patients treated for TB between 1997 and 1999. New entrants were screened in 1999. Outcomes measured were numbers of cases of active tuberculosis detected and numbers of those screened given chemoprophylaxis.

Results: A total of 643 contacts of 227 cases of active TB were seen, and 322 new entrants to the United Kingdom. The highest proportion of contacts requiring full treatment or chemoprophylaxis were contacts of smear-positive index cases (33 out of 263 contacts; 12.5 per cent). Tracing contacts of those with smear-negative pulmonary tuberculosis (12 out of 156; 7.7 per cent) and non-pulmonary disease (14 out of 277; 6.2 per cent) was significantly more effective in identifying individuals requiring intervention (full treatment or chemoprophylaxis) than routine screening of new entrants (10 out of 322; 3.1 per cent).

Conclusions: Screening for TB of new entrants to the United Kingdom is part of the national programme for control and prevention of TB, whereas tracing contacts of those with smear-negative and non-pulmonary disease is not. This study demonstrates that, in our population, the contact-tracing strategy is more effective than new entrant screening. It is not likely that the contacts have caught their disease from the index case, but rather that in high-incidence areas such as ours such tracing selects extended families or communities at particularly high risk.