Background: Early adoption of PCSK9 monoclonal antibodies and small-interfering RNA therapies depends on clinical-trial access. Yet communities with the highest cardiovascular burden—often socioeconomically deprived—are under-represented in lipid-lowering trials. Hypothesis: In the Southern U.S, Phase III lipid-lowering trial sites cluster near socioeconomically advantaged cities, forcing residents of more deprived cities to travel farther to participate. Aim: Quantify association between city-level socioeconomic deprivation and drive time to the nearest Phase III trial site. Methods: We conducted a cross-sectional geospatial analysis of Phase III trials for Inclisiran, Evolocumab, and Alirocumab initiated between 2015-2020. Trial locations were extracted from ClinicalTrials.gov, geocoded, and de-duplicated. All Census-defined Southern U.S cities with ≥50,000 residents in 2020 were included (n=284). Socioeconomic deprivation was measured with the Area Deprivation Index (ADI; higher=greater deprivation). Typical drive time from each city center to nearest trial site was computed using Google Distance Matrix API. Minority-majority status (≥50% racial minority) served as a covariate. Generalized Estimating Equations with a gamma distribution and log link, clustered by city, estimated percent change in drive time per one-point ADI increment. Results: Of the 284 cities in the study, 151 (53%) were minority-majority. 73 cities (26%) contained a trial site and yielded 849 city–site dyads. Median drive time was 36 min (IQR 21–91); 58% of cities required ≥30 min and 38% ≥60 min of travel. Each one-point ADI increase was associated with a 2.1% longer drive time (β=0.0212, 95% CI 0.017–0.025; p<0.001). Moving from the 25th to the 75th ADI percentile more than doubled predicted travel burden. After adjustment, minority-majority cities had a 21.7% shorter drive time than non-minority-majority cities (β = -0.245, 95% CI -0.438 to -0.053; p=0.013), reflecting concentration of sites in a few large, diverse hubs. Results were robust to driving distance, PCSK9 inhibitor-only analyses, and city-level clustering. Conclusions: Southern U.S cities with greater socioeconomic deprivation face substantially longer travel times to Phase III lipid-lowering clinical trials, potentially limiting early therapeutic access and perpetuating evidence gaps. Strategic placement of future trial sites in deprived areas is essential for equity and generalizability in cardiovascular drug development.

This article explores the processes enabling shared housing for students and young professionals as a strategic housing segment for the regeneration of post-industrial cities. It analyses the development of purpose-built student accommodation and related forms of high-density shared housing, as well as co-living, in university cities along the Walloon industrial axis (Belgium). Using desk research and expert interviews, the article examines how specific types of shared housing for young adults align with the strategic interests of municipalities and the market in post-industrial contexts. It further shows how a flexible, fragmented regulatory framework contributes to balancing those interests and power relationships in establishing a shared housing market. In these post-industrial cities facing concerns about competitiveness, purpose-built student accommodation and co-living respond to municipalities’ interests in attracting and anchoring young professionals – seen as economic levers – as well as regenerating deprived city centres and former industrial areas. Local companies and international investors strategically meet public interests by delivering professionally managed shared housing, branded as high quality and affordable for the target demographic. While flexible regional planning and housing frameworks facilitate these developments, the lack of local enforcement hampers their effective regulation. Notably, municipalities may also be opposed to shared housing due to single-family housing subdivision. The article’s conclusion section discusses the relationship between public and private interests, the underpinning discourses and their possible implications. It further points to the potential for specific actors and strategic instruments to help local governments better steer shared housing development and address the risks.

Background & Aims Participating in specialized nursing empowerment training programs can improve nurses’ skills. Empowering nurses is very important for providing quality care. This study aimed to investigate the impact of an empowerment training program on the job satisfaction of nurses in Iran. Materials & Methods This is a quasi-experimental study with a pre-test/post-test design. The study population consists of all nurses working in the hospitals of eight deprived cities in Iran (Ahvaz, Hormozgan, Zahedan, Ilam, Abadan, Zabol, Torbat-e Jam and Iranshahr) in 2018-2019. We selected 240 nurses with a work experience <20 years from the special wards of hospitals (ICU, CCU, dialysis, emergency) using a purposive sampling method. They were divided into two groups of intervention (n=120) and control (n=120) who were matched based on educational level, gender, work experience and age. A specialized training program was provided to the intervention group based on Kirkpatrick’s training evaluation model for three months (one 90-minute session per week), but the control group did not receive any training. ANCOVA was performed for statistical analysis in SPSS software, version 16. Results Job satisfaction after intervention was significantly different between the two groups (F=152.37, P=0.001). Empowerment training could significantly increase nurses’ job satisfaction. Conclusion Empowerment training can increase the job satisfaction of Iranian nurses. Therefore, continuous in-service empowerment training programs for nurses are recommended to promote their job satisfaction. The results of this study can help healthcare officials and policymakers in Iran identify factors affecting nurses’ skills and performance.

Aims: Drug-related deaths are a tragedy, with socioeconomic deprivation associated with higher rates. Globally deaths have increased with most involving an opioid. We aimed to assess the rates and causes of drug-related deaths for a deprived city in Northern England, compared with the surrounding less deprived semirural county (with pockets of high deprivation) against national data. We want to assess whether there is an association of deaths with higher deprivation levels.Methods: Drug-related deaths in 2022 were provided by Dr Copeland via the National Programme of Substance Use Mortality (NPSUM) using postmortem (PM) records. Two deaths did not have full postcodes, so not included where location was required. We assessed deaths against demographics, implicated drugs, prescribed medications, comparing with Indices of Multiple Deprivation (IMD) by postcode. Regional deaths were compared with Office for National Statistics (ONS) death rates. Statistical analysis via Excel.Results: In 2022, there were 91 deaths for the city and county (14.8/100,000) significantly higher than (8.14/100,000) in England and Wales (X²=16.4, p<0.00001). The city had significantly more deaths (N=67;25.0/100,000, X²=95.6, p<0.00001) versus the county (N=18;5.2/100,000). Mean age of death 43.2±9.0 and 23% were women. Most deaths in the county occurred in urban areas. Median age of death for Males was 42.6 yrs. and Females 45.2 yrs. (SD±9.0). Most implicated drug causing death was heroin and morphine (23.1%), methadone (16.5%) like national data, whilst benzodiazepines (15.4%) were higher than national (p>0.05). Most deaths were caused by more than one implicated drug 82.4%. 64.8% of deaths occurred in a person known to be using drugs. Many deaths had methadone implicated (N=28; 30.8%) and 50 deaths had methadone at PM of which 11 were prescribed. Most deaths (N=55; 64.7%) occurred in the top decile of IMD and occurred in the top 4.4% most deprived neighbourhoods.Conclusion: Socioeconomic deprivation was associated with higher rates of drug-related deaths; most deaths occurred in the most deprived areas. Addressing deprivation-related risks in economically challenged areas is critical to effectively tackling drug deaths and health inequalities. The cause of death was most often opioids and strategies such as take-home naloxone and optimising opioid substitution treatment will be vital to reduce deaths. We note a high proportion of deaths had methadone, which was not prescribed, present at postmortem, indicating that prescribed methadone may have been diverted. Drug services may consider strategies to increase use of supervised consumption as per guidelines to reduce diversion and associated deaths.

BackgroundPeople-centred initiatives to create and retain local wealth, such as Community Wealth Building (CWB), have potential to stimulate regional economic regeneration that addresses economic inequalities by increasing the economic inclusion of more disadvantaged groups. Preston, a relatively deprived city in England, has implemented a CWB programme that has been associated with improvements in local wages and well-being. We estimated the effect of Preston’s CWB programme on employment and examined differential effects by disability status and other equality dimensions.MethodsWe conducted a difference-in-differences analysis combined with entropy balancing to estimate the effect of the introduction of the CWB programme in Preston on local employment rates, using individual-level data from the Annual Population Survey collected between 2011 and 2019. We performed subgroup analysis to investigate whether the effect on employment was modified by disability, ethnic group, sex or education level.ResultsWe analysed survey responses from 95 476 individuals. The introduction of the CWB programme was associated with an increase in the employment rate of 4% (95% CI 2.4% to 5.7%) among people living in Preston, compared with what would have been expected in the absence of the programme. The effect on employment was greater among people with disabilities, minority ethnic groups, men and people with lower levels of education.ConclusionsOur findings indicate that CWB can have a positive impact on employment over a relatively short period of time, which disproportionately benefits people with disabilities and other disadvantaged groups. This evidence can be used to inform the development, implementation and evaluation of CWB strategies in other places. Preston’s CWB programme may represent a strategy to achieve more equitable economic growth and reduce health inequalities.

It is common for health education and promotion to be an essential part of GP consultations with families. This QI project trialled ways to provide community health education and promotion to surrounding families of a busy and deprived city GP practice. We aimed to compare the effectiveness of different face-to-face methods. Through a local child community centre, we organised two health promotion events. First, we held a drop-in session, where parents discussed topics of concern. Second, we organised an information session where we discussed different child health conditions and management with families. We obtained feedback on the usefulness of these sessions and changes in confidence of parents in managing their child's health. 10 families joined the drop-in session. 83% of parents gave the session a usefulness score of 5/5, with 100% of parents feeling more confident at managing their child's health.6 families joined the information session. 83% responders rated the session's usefulness as 5/5. When asked how much their confidence had increased, 50% of parents gave a 4/5 and 50% responded with a 5/5. While the study is limited by sample size, drop-in and information sessions were perceived by parents as useful and increased their confidence in managing their child's health. More families joined the drop-in session and expressed higher confidence, indicating similar sessions could be useful to the wider community. Both types of session, however, could bring benefit to a community and success is likely dependent on the resources available and uptake by parents.

Seasonal influenza causes around 15,000 deaths yearly in the UK. While vaccination is a useful prevention measure, uptake is low, related to factors such as deprivation, age, sex, and ethnicity. Liverpool is a diverse yet deprived city, with potentially interacting population-level factors which require examination prior to targeted intervention development. A retrospective cross-sectional analysis of electronic health records in Liverpool used meta-analysis to examine associations between vaccine uptake and deprivation, sex, age group, and ethnicity. Overall prevalence rates for vaccination between September 2022 and March 2023 were 25·8% (95% CI: 23·8% to 28·0%). All factors were associated with uptake, which was lowest in: more deprived General Practices (family doctor; primary care physician), males, children aged 0-1, and in people identifying as Any Other ethnicity. Individuals identifying as White or Mixed/Multiple ethnic groups were most likely to be vaccinated, while those identifying as Black, Black British, Caribbean or African, and Asian or Asian British had lower uptake. Similarly, rates were higher in individuals aged 2-3, 4-10, and 65+ than 16-64, while no difference was found between the latter group and ages 11-15. Deprivation did not interact with age, sex, or ethnicity. These findings support that deprivation, age, sex, and ethnicity influence influenza vaccine uptake, and that they do so uniquely in Liverpool. While deprivation did not interact with other characteristics, this may be due to the impact of inequality (large deprivation gap between richer and poorer areas) on the whole city, as this is as a social stressor that can impair health outcomes for all, not just those in more deprived areas. Future work should investigate experiences of people in areas with lower uptake in Liverpool, to understand potential barriers and enable targeted intervention.

HintergrundGegenstand der Geografie ist unter anderem die Analyse raumzeitlicher Veränderungen von Strukturen und Prozessen. Die Gesundheitsgeografie wendet Methoden, Modelle und Paradigmen der Geografie auf gesundheitsspezifische Fragestellungen an. Am Beispiel der COVID-19-Pandemie in Bremen soll die geografische Perspektive auf Gesundheit aufgezeigt sowie deren Nutzen verdeutlicht werden.MethodenGrundlage der Untersuchung sind raumzeitliche Daten der COVID-19-Neuinfektionen nach Kalenderwoche auf Ortsteilebene in der Stadt Bremen zwischen März 2020 und Mai 2022. Neben den Fallzahlen wurden zur Erklärung dieser ausgewählte Indikatoren zur soziodemografischen Lage (z. B. Haushaltsstruktur, Sozial- und Migrationsstatus) berücksichtigt. Die raumzeitlichen Analysen erfolgten deskriptiv sowie unter Verwendung linearer Regressionsmodelle.ErgebnisseDie erste Pandemiewelle zeigt deutliche lokale Unterschiede und hohe Inzidenzen bzw. Periodenprävalenzen in einzelnen Ortsteilen. Für die späteren Wellen konnte eine Clusterbildung mit hohen Fallzahlen in vorwiegend deprivierten Ortsteilen identifiziert werden. Beispielsweise zeigt sich in der 2. Welle u. a. eine Assoziation zwischen den Fallzahlen und der Anzahl der Personen pro Haushalt (β = 1,099, p < 0,001), in der 4. Welle mit der Quote von Bürgergeldempfängern nach dem zweiten Sozialgesetzbuch (SGBII; β = 0,056, p = 0,004).DiskussionDie Ergebnisse zeigen räumliche Unterschiede in den COVID-19-Fallzahlen und eine stärkere Belastung von deprivierten Ortsteilen. Die Untersuchung hat den hohen Nutzen einer raumzeitlichen Perspektive, hier am Beispiel der COVID-19-Pandemie in Bremen, aufgezeigt. Dies betrifft nicht nur die Analyse der Pandemiedynamik, sondern auch aus Public-Health-Perspektive die Identifizierung vulnerabler Bevölkerungsgruppen sowie die gezielte Implementierung von Präventionsmaßnahmen.

Micro and macro urban heat islands in an industrial city: Bradford, UK

PurposeTo estimate variation in emotional and behavioural problems between primary schools in Bradford, an ethnically diverse and relatively deprived city in the UK.MethodsWe did a cross-sectional analysis of data collected from 2017 to 2021 as part of the ‘Born In Bradford’ birth cohort study. We used multilevel linear regression in which the dependent variable was the Strengths and Difficulties Questionnaire (SDQ) total score, with a random intercept for schools. We adjusted for pupil-level characteristics including age, ethnicity, socioeconomic status, and parental mental health.ResultsThe study included 5,036 participants from 135 schools. Participants were aged 7–11 years and 56% were of Pakistani heritage. The mean SDQ score was 8.84 out of a maximum 40. We estimated that the standard deviation in school-level scores was 1.41 (95% CI 1.11–1.74) and 5.49% (95% CI 3.19–9.37%) of variation was explained at school level. After adjusting for pupil characteristics, the standard deviation of school-level scores was 1.04 (95% CI 0.76–1.32) and 3.51% (95% CI 1.75–6.18%) of variation was explained at school level. Simulation suggested that a primary school with 396 pupils at the middle of the distribution has 63 pupils (95% CI 49–78) with a ‘raised’ SDQ score of 15 + /40; and shifting a school from the lower to the upper quartile would prevent 26 cases (95% CI 5–46).ConclusionThe prevalence of emotional and behavioural problems varies between schools. This is partially explained by pupil characteristics; though residual variation in adjusted scores may suggest that schools have a differential impact on mental wellbeing.

Traffic safety is an area of great importance, since there are many traffic accidents every day in which a significant number of people are killed. Defining certain strategies and identifying potentially the most dangerous towns and cities regarding this area are, on the one hand, a necessity, and, on the other hand, a challenge. In this paper, integrated Multi-Criteria Decision-Making (MCDM) model for ranking cities in Libya from the aspect of traffic safety has been proposed. The model implies a set of 8 criteria on the basis of which 5 decision-makers rated the 10 most deprived cities in Libya. The Full Consistency Model (FUCOM) in combination with the rough Dombi aggregator is used to determine the significance of the criteria. The Rough Simple Additive Weighting (R-SAW) method is used to rank the alternatives. The rough Dombi aggregator is also used for averaging in group decision-making while evaluating the alternatives. The stability of the model and the obtained results has been verified by the sensitivity analysis, which implies a 2-phase procedure. In the 1st phase, rough Additive Ratio Assessment (R-ARAS), Rough Weighted Aggregated Sum Product Assessment (R-WASPAS), Rough Complex Proportional Assessment (R-COPRAS) and Rough Multi-Attributive Border Approximation-area Comparison (R-MABAC) methods are applied. The 2nd phase implies changing the parameter ρ in the procedure of rough Dombi aggregator, while the 3rd phase includes the calculation of Spearman’s Correlation Coefficient (SCC) that shows a high correlation of ranks.

Aim of the Study: The aim of this research paper was to develop the household deprived health and education index for thirteen cities of Pakistan. The paper also identifies the impact of uncertain food prices (volatility in food prices) on household health and education deprivation. Methodology: The study conducted using the methodology of pseudo panel fixed effect for four waves of PSLM data. Findings: The results also explained that the volatility in food prices increase the deprivation in both dimensions i.e., health and education. Conclusion: It is concluded that in terms of education deprivation Quetta is the most deprived large city and stand at the 1st rank while, Bahawalpur is the most deprived city in terms of household health in 2014-15. The study recommended that government should build more schools and health care centers to provide free quality education and medical treatment.

BackgroundAir pollution is a major cause of morbidity and mortality. Clean Air Zones (CAZs) which restrict the entry of polluting vehicles in targeted areas have been identified as potentially effective in improving health and reducing air pollution; however, their implementation can be controversial. MethodsA cross-sectional survey was completed by 1949 respondents who lived or worked in Bradford, a multi-cultural deprived city in England, between April and December 2021. Of these, 1137 were recruited from the longitudinal Born in Bradford (BiB) family cohort (families with children born in the city during 2007–2011) and 812 were from the general public. Bradford is the seventh largest metropolitan district in England and Wales with a population of over half a million mainly white British and Pakistani origin. The BiB families cohort and the general public respondents were used for descriptive analysis of perception of air quality and acceptability of CAZ, then the relationship between participants responses with demographic characteristics were investigated using the BiB families cohort. Outcomes included perceptions of air quality and acceptability of the CAZ supplemented by free-text questions. Thematic analysis was used to code free-text data. Descriptive analyses were performed on the entire sample. Latent class analysis was used to characterise participants was performed in the BiB dataset for whom detailed existing socio-demographic data were available. ResultsThe majority of participants (67%) considered improving air quality in Bradford as extremely important; 70% supported implementation of the CAZ. Three latent classes were identified within the BiB sample: deprived white British families (25%), more affluent white British families (32%) and deprived Pakistani-origin families (43%). Deprived white British (OR = 0.54, 95% CI: 0.34 to 0.84) and more affluent white British families (OR = 0.53, 95% CI: 0.36 to 0.79) were less likely to say the air quality was good/excellent when compared with deprived Pakistani-origin families. Affluent White British families were more likely to support the CAZ compared with deprived white British families (OR = 2.24; 95% CI: 1.55. to 3.25) and deprived Pakistani-origin families (OR = 2.06, 95% CI: 1.50 to 2.85). Qualitative analysis suggested that a perceived lack of cohesion in the policy and concerns about financial impacts drove negative attitudes. ConclusionFamilies in Bradford were generally supportive of the planned CAZ and efforts to reduce pollution; however, support was weaker in more deprived communities. Pakistani-origin communities living in deprived areas perceived air quality as better than other groups. Tailored approaches to communicate about the proposed benefits of policies such as CAZ prior to implementation may be an important way to increase acceptability amongst vulnerable groups.

Purpose Williams and Williams (2012, 2017) find multiple entrepreneurial motivations are experienced by entrepreneurs in deprived areas at different points in time. Drawing on this prior work this study aims to explore how and why the shifted motivations evolve, as well as, what factors cause this change in deprived areas. The work draws upon temporal motivational theory (TMT) that considers the influence of individuals' needs in determining their time-sensitive motivation. Design/methodology/approach Six semi-structured interviews with actual entrepreneurs are used to collect qualitative data from deprived areas of Nottingham, which is one of the most deprived cities in the UK. The study employs Interpretative Phenomenological Analysis (IPA) to consider each entrepreneurial endeavour as a unique journey to investigate the shifting of motivations. Findings A polarization is found in terms of how entrepreneurial motivations evolve in deprived areas. In considering the first task-specific entrepreneurial motivation, time plays a role either in accumulating job dissatisfaction and increasing confidence led by accumulated experience, or in creating random chances that enable individuals to realize that they are able to use existing skills and experiences to start a business. Regarding the second task-specific entrepreneurial motivation when the business becomes more established, it is usually stimulated by increased confidence based on perceived progress. The use of self-help methods and downward comparison found in this study should be noted as they help to re-consider individuals' needs in deprived areas. Originality/value This study produces a more comprehensive understanding of the phenomenon of the time effect on shifted motivation at different entrepreneurial phases in a deprived context, which contributes to enrich theoretical knowledge and raise policymakers' awareness of entrepreneurial motivations from these marginalized groups.

BackgroundInvolving communities in research priority setting can increase the relevance and efficiency of research, leading to better health outcomes. However these exercises often lack clarity in how communities are involved and the extent to which priorities are acted upon is unclear. Seldom-heard groups, for example ethnic minorities may experience barriers to participation. We report methods and outcomes of an inclusive co-produced community research priority setting exercise within the multicultural and deprived city of Bradford, UK. The aim was to identify priorities for keeping children happy and healthy and was undertaken by the Born in Bradford (BiB) research programme to inform future research agendas.MethodsA 12 member multi-disciplinary, multi-ethnic community steering group led the process using a modified James Lind Alliance approach between December 2018-March 2020. Research priorities were collected through a widely distributed paper and online survey. Respondents were asked to list three important things to keep children i) happy, ii) healthy and what needs to change to improve either health or happiness. Free text data were coded iteratively by community researchers, and shared priorities were co-produced in a series of workshops and meetings with the community steering group and community members.ResultsFive hundred eighty-eight respondents to the survey identified 5748 priorities, which were coded into 22 themes. These covered a range of individual, social and wider socioeconomic, environmental and cultural priorities. Diet/nutrition and exercise were most commonly identified as important for health, including what needs to change to improve health. For happiness, home life and family relationships, listening to children, and education/activities were the most commonly identified. Community assets were identified as important to change for both health and happiness. From the survey response the steering group developed 27 research questions. There were mapped onto existing and planned research agendas within BiB.ConclusionsCommunities identified both structural and individual factors as important priorities for health and happiness. We demonstrate how communities can be involved in priority setting using a co-productive approach in the hope this can be used as a model for others. The resulting shared research agenda will shape future research to improve the health of families living in Bradford.

Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow — North Glasgow and East End – and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders.The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the “right” to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.

Urban regeneration has become an essential spatial strategy to resolve urban decay issues in many countries and regions which is in line with the ‘2030 Agenda for Sustainable Development to build sustainable cities and communities worldwide. Although urban regeneration is the desired solution for deprived cities, not all are successful in following the sustainable development path as more emphasis is on economic objectives over the environment and social sustainability. Thus, this study presents the conceptual framework that integrates sustainable development aspirations in the urban regeneration practice as the way forward. A qualitative method (content analysis approach) is adopted in this study by reviewing current and past studies on sustainable urban regeneration, using Mendeley as the search engine and ATLAS.ti for analysing. Findings from the literature review identified fundamental criteria and indicators of sustainable urban regeneration according to the three dimensions of sustainable development. A strategic approach to achieving sustainable urban regeneration is also identified which indicates that planning and social sub-systems are the crucial components or the enablers that integrate sustainability in urban regeneration initiatives. This study concluded that urban regeneration could be the solution to resolve urban decay and build sustainable cities if the town planning and social sub-system are incorporated appropriately within the sustainable urban regeneration framework.

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi-structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and 'upskill' hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site-specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on 'quick' discharges.

Abstract. Breast cancer is the most common women's cancer that more than 90% of the patients can be treated or even cured through early diagnosis. So we intend to investigate the status of breast cancer screening in Khorramabad, a city in the west of Iran. In the present cross-sectional study, the study population included 457 number of 20 to 65 year old women referring to the health centers of Khorramabad during the second half of 2015 to receive health care services. The sampling method was multistage random-cluster. A multi-part questionnaire were used. Fisher exact test, chi-square and independent t tests were used to analyze the data. The regular self-breast exam (SBE) had been carried out by 12.3% of the women, visiting doctors for regular clinical breast exam (CBE) had been done by 6% of the respondents and regular mammography every one to two years had been performed by 2.4% of the women. A statistically significant relationship was seen between occupation (P = 0.001), regular consumption of contraceptive pills (P = 0.032), history of breastfeeding, history of breast cancer in the first degree relatives (P = 0.001), and a history of cancer in the second degree (P = 0.005) relatives, and the regular SBE. Planning to enhance the women's awareness about breast cancer and the methods of early diagnosis and designing educational programs can be an important step to reduce deaths and disabilities caused by this disease among the women in such deprived cities.

BackgroundMany health systems are experimenting with integrated care models to improve outcomes and reduce healthcare demand. Evidence for effects on health service utilisation is variable, with few studies investigating impacts on mortality or differences by socioeconomic group. ObjectiveTo examine the impact of a multidisciplinary, integrated care team intervention on emergency admissions and mortality, and whether effects differed by deprivation group. DesignA longitudinal matched controlled study using difference-in-differences analysis comparing the change in unplanned emergency admissions twelve months before and after the intervention, and inverse probability of treatment-weighted survival analysis comparing mortality, between intervention and matched control groups. SettingA relatively deprived city in England, U.K. InterventionA case-management integrated care programme delivered through multidisciplinary teams and aimed at complex needs and/or high hospitalisation risk patients. ResultsThe intervention was associated with a small increase in emergency admissions of 15 per 1,000 patients per month (95% CI 5 to 24, p = 0.003) after the intervention relative to the control group and no significant change in survival between intervention and control groups (HR 0.9, 95% CI 0.84 to 1.13, p = 0.7). Effects were similar across age and deprivation groups. ConclusionsIt is unlikely that similar interventions lead to reduced emergency admissions or increased survival. Further studies should use experimental methods and assess impacts on quality of life.