Evidence-based Public Health Interventions Research Articles

Development and cost estimates of an integrated noncommunicable disease registry in North India: A study protocol

Background: Out of the total deaths globally, noncommunicable diseases (NCDs) account for 72%. In India, as per the Global Burden of Disease Estimates 2016, NCDs contributed to 62% of the deaths and 55% of the disability-adjusted life years (DALYs), thereby posing a huge burden. In low- and middle-income countries, NCD burden estimates are either not available or that are available are insufficient. Hence, the tools to be used in developing countries similar to that in India are disease registries which work as a powerful method to record the data for NCDs.Methods: The integrated registry will be developed in Chandigarh (UT), North India. The situational analysis of operationalization of the existing individual NCD registries of Chandigarh will be done with baseline assessment for core and advanced activities. From a review of the existing tools of varied registries, the integrated tool will be developed and validated. The integrated registry will also be developed as m-registry, i.e., the questionnaire in the form of mobile-based application will be linked to a web-based server so as to make the real-time data entry. Economic evaluation of the isolated NCD registries will be done so as to find the cost of per case registered, on the basis of which the cost of operationalizing an integrated NCD registry will be developed.Discussion: The integrated registry would mean integration in terms of uniform reporting system for different NCDs such as cancer, diabetes at a younger age, acute cardiac events, and stroke, with a separate portion for each disease and pooling of human resources which will ultimately help in developing integrated evidence-based public health interventions for prevention and control. The Barbados' multi-NCD registry has developed a disease surveillance model to record NCD with the phased introduction of one registry component per year with the pooling of human resource and data at one place. A similar model of integrated registry has been developed in the Philippines.

Non-fatal suicidal behaviour, depression and poverty among young men living in low-resource communities in South Africa

BackgroundSuicide is a serious public health problem in low- and middle-income countries. Understanding the context- and gender-specific risk factors for non-fatal suicidal behaviour is the cornerstone of evidence-based public health interventions to reduce suicide. Poverty and symptoms of depression are well established risk factors for suicidal behaviour. However, little is understood about how proximal economic factors (such as losing one’s job, or food insecurity) may confound the effects of symptoms of depression to increase the risk of non-fatal suicidal behaviour in vulnerable populations, such as young men living under conditions of endemic poverty. The aim of this study was to explore the extent to which a wide range of poverty-related variables account for non-fatal suicidal behaviour independent of, or in addition to, symptoms of depression among young men living in low-resource communities in South Africa (SA).MethodsData were collected from a clustered sample of 647 young men living in low-resource communities in the Western Cape province of SA. Multivariate regressions were used to identify the associations between poverty-related measures, symptoms of depression, and past-month prevalence of non-fatal suicidal behaviour.ResultsNon-fatal suicidal behaviour in the last month was reported by 47 (6.13%) participants: suicidal ideation (n = 43; 5.97%); suicide plan (n = 5; 0.77%); suicide attempt (n = 4; 0.62%), and deliberate self-harm without intent to die (n = 4; 0.62%). Past-month prevalence of non-fatal suicidal behaviour was significantly associated with particular dimensions of poverty (living in a home without a toilet on the premises, having previously been fired, and food insecurity), but not with other dimensions of poverty (such as prolonged unemployment and low levels of income). However, symptoms of depression were a more significant predictor of non-fatal suicidal behaviour than any measure of poverty (aOR=1.093, 95% CI=1.058-1.129, p < .000).ConclusionsDepressive symptoms are more strongly associated with non-fatal suicidal behaviour than a range of proximal and distal economic factors among young men living under conditions of endemic poverty in South Africa. This has important public health implications and highlights the importance of increasing young men’s access to psychiatric services and targeting depression as an integral component of suicide prevention in low resource communities.

An assessment of progress in cancer control

This article summarizes cancer mortality trends and disparities based on data from the National Center for Health Statistics. It is the first in a series of articles that will describe the American Cancer Society's vision for how cancer prevention, early detection, and treatment can be transformed to lower the cancer burden in the United States, and sets the stage for a national cancer control plan, or blueprint, for the American Cancer Society goals for reducing cancer mortality by the year 2035. Although steady progress in reducing cancer mortality has been made over the past few decades, it is clear that much more could, and should, be done to save lives through the comprehensive application of currently available evidence-based public health and clinical interventions to all segments of the population. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.

Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis.

More than 10 million new cases of tuberculosis (TB) are diagnosed worldwide each year. The majority of these cases occur in low- and middle-income countries where the TB epidemic is predominantly driven by transmission. Efforts to 'end TB' will depend upon our ability to halt ongoing transmission. However, recent studies of new approaches to interrupt transmission have demonstrated inconsistent effects on reducing population-level TB incidence. TB transmission occurs across a wide range of settings, that include households and hospitals, but also community-based settings. While home-based contact investigations and infection control programmes in hospitals and clinics have a successful track record as TB control activities, there is a gap in our knowledge of where, and between whom, community-based transmission of TB occurs. Novel tools, including molecular epidemiology, geospatial analyses and ventilation studies, provide hope for improving our understanding of transmission in countries where the burden of TB is greatest. By integrating these diverse and innovative tools, we can enhance our ability to identify transmission events by documenting the opportunity for transmission-through either an epidemiologic or geospatial connection-alongside genomic evidence for transmission, based upon genetically similar TB strains. A greater understanding of locations and patterns of transmission will translate into meaningful improvements in our current TB control activities by informing targeted, evidence-based public health interventions.

12 - Awareness and knowledge of anal cancer in a community-recruited sample targeting people with HIV and gay/bisexual men

Background Anal cancer disproportionately affects gay and bisexual men (GBM), especially those with HIV infection. We explored the awareness and understanding of human papillomavirus (HPV) and anal cancer in a community-based cohort, to inform future evidence-based public health interventions. Methods Participants recruited through advertisements at gay and HIV community organisations completed an anonymous online questionnaire that assessed knowledge, understanding and experience of anal HPV, HPV vaccination, anal cancer screening and perceived personal risk of anal cancer. Results Of 1660 questionnaires returned, 1535 (92.5%) were from GBM, of whom the majority thought their risk of anal cancer was the same, or lower, than that of the general population. 196 (13.5%) participants reported ever having talked to their doctor about anal HPV and/or anal cancer. The discussion was initiated by the patient in more than half (58.7%) of cases, but was more likely to be doctor-initiated by participants who were HIV positive than negative/unknown (51.6% vs 35.7%, p=0.037). Only a small minority (12.7%) had talked to their doctor about anal HPV and/or anal cancer and (11.8%) had an anal cancer examination. Less than one third (32.3%) had heard of HPV vaccination and only 3.0% of men aged ≤ 26 years had received HPV vaccination. Conclusions Knowledge and awareness of anal cancer was generally very poor in GBM, who are at elevated risk of anal cancer. Specific information targeted at this group could potentially raise awareness, leading to earlier diagnosis and improved outcomes. Young GBM need education around the importance of HPV vaccination.

Contemporary perspective on the role of community pharmacists in oral health promotion.

Our oral health is an important part of our general health and wellbeing, and requires a range of providers to work in partnership to effectively provide oral health promotion. Cheryl Else, from Manchester Metropolitan University, explores the role community pharmacies can play in reducing oral health inequalities.[Image omitted: See PDF.]According to a recent report by Public Health England (PHE)[1] for local authorities, it was acknowledged that oral health is an important part of general health and wellbeing, and that both share common risk factors such as smoking, alcohol misuse and unhealthy diets.Since 2012, local authorities have been statutorily required to provide or commission oral health promotion programmes to improve the oral health of their local population to a standard appropriate for their area.[1] They can integrate these programmes into existing services or tender for new partnerships.[1] A range of providers already deliver oral health programmes that have been developed from evidence-based research.[1]To be effective, oral health promotion requires a range of providers who can work in partnership, and community pharmacists could play a specific role in this area.According to a review by Mann et al.,[2] community pharmacists already provide essential services in general health promotion and are frequently asked questions on oral health issues. Furthermore, pharmacists are willing to incorporate oral health promotion into their existing role as long as the right support is in place.[2] This support would need to include further training in understanding contemporary evidence-based dental public health interventions and incorporation of oral health promotion into their existing NHS contract.[2]The Royal Society for Public Health (RSPH) and PHE[3] researched the role community pharmacies currently play in health promotion and the future role they could play with the right support in place. This would enable them to reach their full potential in health-promoting activities.[3] Through the 'community pharmacy contractual framework', some health-promoting activities are already an integral part of the community pharmacies role including prescription-linked healthy lifestyle advice, smoking cessation and signposting to other health services.[3] In addition, many pharmacies are commissioned by local authorities to deliver other public health services such as weight management programmes or NHS health checks, but as the report highlighted, there are challenges that still need to be overcome to make 'healthy living pharmacies' a truly viable option across the UK.[3] These challenges include financial, infrastructure and training issues.[3] However, policies and structures could be put in place to address these issues allowing all community pharmacies on our high streets to play an important part in reducing health and oral health inequalities.Oral Health InequalitiesWhile there has been a general decline in dental decay, it remains a disease that has become increasingly concentrated in high-risk groups and closely linked with social and economic deprivation.[4]In 2016, PHE published their epidemiology report on the prevalence and severity of dental decay,[5] which revealed huge variations at local and regional authority levels and confirmed previous studies which found that most of the dental decay is found in children of poor economic and social backgrounds, with ethnicity also a factor.The results of that epidemiology survey found that the overall percentage of 5-year-old children in England free from visually obvious dental decay was 75.2% and the national average overall for England with regard to number of teeth affected by dental decay was 0.8 decayed, missing or filled teeth (DMFT); but this number increases to 3. …

Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis.

BackgroundDespite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents.MethodsPRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs.Inclusion resultsThe written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced.DiscussionThe PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school.Trial registrationClinicalTrials.gov (NCT01688453).

The mobile monitoring of black carbon and its association with roadside data in the Chinese megacity of Shanghai.

High-level black carbon (BC) pollution is associated with traffic emissions in metropolitan areas with high vehicle density. Mobile monitoring was conducted to assess the in-vehicle BC exposure on three backbone ring roads (inner, middle, and outer ring roads) on October 14 and October 18, 2015 in Shanghai. Ambient BC monitoring was also simultaneously conducted in three fixed roadside stations from October 14 to October 20, 2015. Results of the mobile monitoring showed median BC personal exposure concentrations ranging from 5.0μgm-3 on the inner ring road to 13.5μgm-3 on the outer ring road. The ambient BC concentrations during the entire observation period showed an arithmetic mean and a standard deviation of 3.5±2.9μgm-3. The correlation analysis of urban roadside monitoring (Caoxi Road and South Zhongshan Road) and personal data showed a high and significant correlation. The results of this study highlight the critical level of BC pollution in Shanghai and facilitate the development of evidence-based public health interventions and control strategies to prevent the adverse health effects of BC pollution.

Pelvic inflammatory disease: improving awareness, prevention, and treatment.

PurposePelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID.Recent findingsThe rates of adverse outcomes in women with PID are high and disproportionately affect young minority women. There are key opportunities for prevention including improving provider adherence with national screening guidelines for STIs and PID treatment recommendations and patient medication adherence. Nearly half of all eligible women are not screened for STIs according to national quality standards, which may increase the risk of both acute and subclinical PID. Moreover, in clinical practice, providers poorly adhere to the Centers for Disease Control and Prevention recommendations for treatment of PID. Additionally, patients with PID struggle to adhere to the current management strategies in the outpatient setting.ConclusionNovel evidence-based clinical and public health interventions to further reduce the rates of PID and to improve outcomes for affected women are warranted. We propose potential cost-effective approaches that could be employed in real-world settings.

Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities.

Cardiovascular health disparities persist despite decades of recognition and the availability of evidence-based clinical and public health interventions. Racial and ethnic minorities and adults in urban and low-income communities are high-risk groups for uncontrolled hypertension (HTN), a major contributor to cardiovascular health disparities, in part due to inequitable social structures and economic systems that negatively impact daily environments and risk behaviors. This commentary presents the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities as a case study for highlighting the evolution of an academic-community partnership to overcome HTN disparities. Key elements of the iterative development process of a Community Advisory Board (CAB) are summarized, and major CAB activities and engagement with the Baltimore community are highlighted. Using a conceptual framework adapted from O'Mara-Eves and colleagues, the authors discuss how different population groups and needs, motivations, types and intensity of community participation, contextual factors, and actions have shaped the Center's approach to stakeholder engagement in research and community outreach efforts to achieve health equity.

Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilities.

BackgroundDespite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking.MethodsData were derived from two prospective cohort studies of people who use illicit drugs in Vancouver, Canada between 2010 and 2014. Multivariable generalized estimating equations were used to identify the prevalence and correlates of public crack smoking and rushed public crack smoking.ResultsIn total, 1085 participants who had smoked crack in the prior six months were eligible for the analysis, of which 379 (34.9 %) reported always or usually smoking crack in public in the previous six months at some point during the study period. Factors positively and independently associated with public crack smoking included public injection drug use (adjusted odds ratio [AOR]: 5.42, 95 % confidence interval [CI]: 3.76-7.82), homelessness (AOR: 3.48, 95 % CI: 2.77-4.36), at least daily crack use (AOR: 2.69, 95 % CI: 2.19-3.31), crack pipe sharing (AOR: 1.98, 95 % CI: 1.60-2.46), drug dealing (AOR: 1.59, 95 % CI: 1.30-1.94), recent incarceration (AOR: 1.47, 95 % CI: 1.09-1.98), noticing police presence when buying or using drugs (AOR: 1.30, 95 % CI: 1.06-1.60), and younger age (AOR: 1.03, 95 % CI: 1.01-1.04). Rushed public crack smoking, which was reported by 216 (28.8 %) of 751 participants who had smoked crack in public at least once during the study period, was positively and independently associated with homelessness (AOR: 2.61, 95 % CI: 1.96-3.49), at least daily crack use (AOR: 1.48, 95 % CI: 1.11-1.98), crack pipe sharing (AOR: 1.44, 95 % CI: 1.10-1.89), drug dealing (AOR: 1.39, 95 % CI: 1.04-1.86), and younger age (AOR: 1.02, 95 % CI: 1.01-1.04).ConclusionsA high prevalence of public crack smoking and rushed public crack smoking was observed in this setting. These findings point to the need for implementing and evaluating evidence-based public health interventions, such as supervised inhalation facilities, to reduce the risks and harms associated with smoking crack in public.

Supporting successful implementation of public health interventions: protocol for a realist synthesis.

BackgroundThere is a growing emphasis in public health on the importance of evidence-based interventions to improve population health and reduce health inequities. Equally important is the need for knowledge about how to implement these interventions successfully. Yet, a gap remains between the development of evidence-based public health interventions and their successful implementation. Conventional systematic reviews have been conducted on effective implementation in health care, but few in public health, so their relevance to public health is unclear. In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health.MethodsThis paper presents a realist review protocol to answer the research question: Why are some public health interventions successfully implemented and others not? Based on a review of implementation theories and frameworks, we developed an initial program theory, adapted for public health from the Consolidated Framework for Implementation Research, to explain the implementation outcomes of public health interventions within particular contexts. This will guide us through the review process, which comprises eight iterative steps based on established realist review guidelines and quality standards. We aim to refine this initial theory into a ‘final’ realist program theory that explains important context-mechanism-outcome configurations in the successful implementation of public health interventions.DiscussionDeveloping new public health interventions is costly and policy windows that support their implementation can be short lived. Ineffective implementation wastes scarce resources and is neither affordable nor sustainable. Public health interventions that are not implemented will not have their intended effects on improving population health and promoting health equity. This synthesis will provide evidence to support effective implementation of public health interventions taking into account the variable context of interventions. A series of knowledge translation products specific to the needs of knowledge users will be developed to provide implementation support.Systematic review registrationPROSPERO CRD42015030052Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0229-1) contains supplementary material, which is available to authorized users.

Predictors and respiratory depositions of airborne endotoxin in homes using biomass fuels and LPG gas for cooking.

Recent studies have highlighted the presence of endotoxin in indoor air and its role in respiratory morbidities. Burning of household fuels including unprocessed wood and dried animal dung could be a major source of endotoxin in homes. We measured endotoxin levels in different size fractions of airborne particles (PM10, PM2.5, and PM1), and estimated the deposition of particle-bound endotoxin in the respiratory tract. The study was carried out in homes burning solid biomass fuel (n=35) and LPG (n=35). Sample filters were analyzed for endotoxin and organic carbon (OC) content. Household characteristics including temperature, relative humidity, and carbon dioxide levels were also recorded. Multivariate regression models were used to estimate the contributing factors for airborne endotoxin. Respiratory deposition doses were calculated using a computer-based model. We found a higher endotoxin concentration in PM2.5 fractions of the particle in both LPG (median: 110, interquartile range (IQR) 100-120 EU/m3) and biomass (median: 350, IQR: 315-430 EU/m3) burning homes. In the multivariate-adjusted model, burning of solid biomass fuel (β: 67; 95% CI: 10.5-124) emerged as the most significant predictor followed by OC (β: 4.7; 95% CI: 2.7-6.8), RH (β: 1.6; 95% CI: 0.76-2.4), and PM2.5 (β: 0.45; 95% CI: 0.11-0.78) for airborne endotoxin (P<0.05). We also observed an interaction between PM organic carbon content and household fuel in predicting the endotoxin levels. The model calculations showed that in biomass burning homes, total endotoxin deposition was higher among infants (59%) than in adult males (47%), of which at least 10% of inhaled endotoxin is deposited in the alveolar region of the lung. These results indicate that fine particles are significant contributors to the deposition of endotoxin in the alveolar region of the lung. Considering the paramount role of endotoxin exposure, and the source and timing of exposure on respiratory health, additional studies are warranted to guide evidence-based public health interventions.

A Seroprevalence Study of Hepatitis B and C Virus Infections in a Hospitalized Population in Romania, an Opportunity for a Better National Prevention and Control Strategy.

The most recent prevalence data for hepatitis B virus (HBV) infection in Romania came from an ESEN 2 study (2002), and from a Romanian population-based study performed in 2008. Most of the previous studies were regional and performed in specific groups (blood donors, pregnant women, institutionalized people, etc) and had limited representativeness at the national level, both for HBV and hepatitis C virus (HCV) infection. The scarcity of prevalence data for HBV and HCV infection coming from the routine surveillance was also considered. The aim of our study was to obtain overall and age group specific estimates of the prevalence of HBV and HCV infections markers in Romania, in order to recommend evidence-based public health interventions. The main outcome was the proportion of persons with HBV, HCV and HBV+HCV infection markers, overall and by age group and gender. Our seroprevalence study ensured national representativeness for the targeted hospitalized population. A prospective collection of serum samples in hospital laboratories was completed between September and November 2013, using a systematic sampling. The study respected the confidentiality of personal data. We calculated the sample size using EpiInfo7 and used Z test - Two-tailed probability for statistical significance. The overall prevalence data estimated in our study were HBc Ab 28%, HBs Ag 4.2%, HBs Ab regardless of titer 64.1%, HBs Ab in titer of at least 10 mUI/ml and negative HBc Ab 17.5%; HCV Ab 5.6%; HBc Ab and HCV Ab 2.8%, as markers of double infection. The overall prevalence data estimated in our study for HBs Ag (4.2%) and HCV Ab (5.6%) correspond to a medium endemicity based on the WHO criteria. The estimated prevalence of HBV and HCV infection markers in the study population should represent an opportunity for a better national prevention and control strategy.

Trends in Quit Attempts Among Adult Cigarette Smokers - United States, 2001-2013.

What is already known on this topic? Quitting smoking is beneficial to health at any age, and cigarette smokers who quit before age 35 years have mortality rates similar to those of persons who never smoked. What is added by this report?During 2001–2010, the proportion of adult cigarette smokers who had made a quit attempt in the past year increased significantly in 29 states and the U.S. Virgin Islands. During 2011–2013, the proportion who had made a quit attempt increased in Hawaii and Puerto Rico and decreased in New Mexico. In 2013, the proportion who had made a quit attempt ranged from 56.2% (Kentucky) to 76.4% (Puerto Rico and Guam) with a median of 65.9%, and was generally lower in older age groups. What are the implications for public health practice? Continued implementation of effective evidence-based public health interventions can reduce the health and costs impacts of smoking-related disease and death and accelerate progress toward meeting the Healthy People 2020 target to increase to ≥80% the proportion of U.S. adult cigarette smokers who made a quit attempt in the past year. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, conducting educational mass media campaigns, and providing insurance coverage for all effective cessation treatments as well as access to quitlines.

Bridging Communication Gaps to Achieve Healthy Weight in Black Children and Families

To identify promising communication approaches that can enhance the ability of academic and community-based researchers, and community advocates to communicate evidence effectively and improve the uptake of evidence-based public health messages and intervention strategies related to obesity prevention for black children and adult caregivers. In August 2014 a national workshop was convened under the auspices of the African American Collaborative Obesity Research Network (AACORN). The workshop included a specific focus on translating and disseminating research on food and built environments to build community awareness - especially among adult caregivers to support efforts to achieve healthy weight in black American children and adolescents. During the workshop, participants heard presentations from experts in obesity and childhood obesity prevention, advertising and marketing, communications, journalism, and youth entertainment education. The SMCRE (Sender, Message, Channel, Receiver, and Effect) Framework was utilized to inform interactive learning activities with workshop participants and communications and marketing experts that generated novel approaches for reaching different segments of the black community with health messages. Results from a workshop evaluation survey indicated that 98% of respondents believed the workshop objectives were met; and over 70% of respondents indicated that they learned new concepts that they will apply to their research/work. The evaluation will also assess the quality and dissemination of promising strategies generated from the workshop. A report on challenges, considerations, and promising strategies to enhance the communication of healthy eating, active living, and healthy weight in black communities is forthcoming on AACORN’s website and will be disseminated via AACORN’s partners.

UK Biobank Urban Morphometric Platform (UKBUMP) – a nationwide resource for evidence-based healthy city planning and public health interventions

The built environment (BE) has emerged as one of the ‘first causes’ of chronic disease, capable of explaining its socio-spatial variation. There is an increasing need for objective, detailed and precise measurements of attributes of BE that may influence our lifestyle, behaviour and hence physical and mental health.In this paper, we report the UK Biobank Urban Morphometric Platform (UKBUMP), the first ever very large sample size high resolution spatial database of urban morphological metrics (morphometrics), being developed for half-a-million participants of the UK Biobank Prospective study spatially distributed across 22 UK cities. Large-scale objective assessment of the BE was conducted employing state-of-the-art spatial and network analyses upon multiple national-level spatial data-sets.Prospective large-scale objective assessment of the BE enables the development of BE-health modelling studies that have the potential to identify causal pathways from specific attributes of the BE to various complex chronic health outcomes as well as well-being. The UKBUMP will act as a national resource, providing a platform for evidence-based healthy city planning and interventions for the first half of the twenty-first century.

Political priority of oral health in Italy: an analysis of reasons for national neglect

Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy. Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous. Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith. There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern. Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.

Can a theoretical framework help to embed alcohol screening and brief interventions in an endoscopy day-unit?

Introduction and aimsThe National Institute for Health Care and Excellence recommend that alcohol screening and brief intervention (ASBI) should be routinely implemented in secondary care. This study used theoretical frameworks...

Applied public mental health: bridging the gap between evidence and clinical practice.

Applied public mental health: bridging the gap between evidence and clinical practice.