Health Information Center Research Articles

Clinical oral microbiology and antimicrobial susceptibility – does it matter?

ABSTRACTLittle surveillance data is undertaken on the antimicrobial susceptibility of isolates from acute dento-alveolar infections. We present data collated from routine diagnostic microbiology specimens submitted over a 27 year period in Glasgow, UK. Over the study period isolates were identified using the API system, VITEK 2 and MALDI-TOF. Antimicrobial susceptibility tests were undertaken using combinations of Stokes method and/or E-tests. Baseline data based on Lewis et al., (JAC 23,69-77 1989) and compared to isolates from 1998-2015. From 621 specimens, we isolated Anginosus group streptococci (n = 196), Mitis group Streptococci (n = 448), anaerobic streptococci (n = 116), Fusobacteria (n = 121) and Prevotella (n = 140) species. No discernable increase in resistance patterns over the 27 year time period of analysis was observed. A 6 month audit (May-Oct 2016) in Glasgow recorded 37 patients hospital admissions for 142 bed days (mean 3.5 days) to incise and drain severe odontogenic infections. But, dental practitioners in England (2015) prescribed 10,717 items of cephalosporins and 18, 630 items of augmentin (Source: Health and Social Care Information Centre) – why?Diagnostic oral microbiology matters in guiding antimicrobial stewardship programs but more collaborative working on processing methods and routine susceptibility data would help overcome limited data from single centers.

Calculating hospital length of stay using the Hospital Episode Statistics; a comparison of methodologies

BackgroundAccurate calculation of hospital length of stay (LOS) from the English Hospital Episode Statistics (HES) is important for a wide range of audit and research purposes. The two methodologies which are commonly used to achieve this differ in their accuracy and complexity. We compare these methods and make recommendations on when each is most appropriate.MethodsWe calculated LOS using continuous inpatient spells (CIPS), which link care spanning across multiple hospitals, and spells, which do not, for six conditions with short (dyspepsia or other stomach function, ENT infection), medium (dehydration and gastroenteritis, perforated or bleeding ulcer), and long (stroke, fractured proximal femur) average LOS. We examined how inter-area comparisons (i.e. benchmarking) and temporal trends differed. We defined a classification system for spells and explored the causes of differences.ResultsStroke LOS was 16.5 days using CIPS but 24% (95% CI: 23, 24) lower, at 12.6 days, using spells. Smaller differences existed for shorter-LOS conditions including dehydration and gastroenteritis (4.5 vs. 4.2 days) and ENT infection (0.9 vs. 0.8 days). Typical patient pathways differed markedly between areas and have evolved over time. One area had the third shortest stroke LOS (out of 151) using spells but the fourth longest using CIPS. These issues were most profound for stroke and fractured proximal femur, as patients were frequently transferred to a separate hospital for rehabilitation, however important disparities also existed for conditions with simpler secondary care pathways (e.g. ENT infections, dehydration and gastroenteritis).ConclusionsSpell-based LOS is widely used by researchers and national reporting organisations, including the Health and Social Care Information Centre, however it can substantially underestimate the time patients spend in hospital. A widespread shift to a CIPS methodology is required to improve the quality of LOS estimates and the robustness of research and benchmarking findings. This is vital when investigating clinical areas with typically long, complex patient pathways. Researchers should ensure that their LOS calculation methodology is fully described and explicitly acknowledge weaknesses when appropriate.

Outcomes in Paediatric Intensive Care Units for Children with Life-Limiting Conditions: A national data linkage study

ABSTRACT
 ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes.
 ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset.
 Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received.
 Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset.
 ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data.
 Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions.
 The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27).
 ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

Child Health Clinical Outcome Review Programme: Health Care Utilisation, Care Pathways and Educational Status in Children and Young People with Adolescent Mental Health problems with a focus on Self harm, Eating Disorders and Anxiety and Depression

ABSTRACT
 ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care.
 In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive.
 ApproachData has been requested from the national data providers in each country:
 
 The Health and Social Care Information Centre - England
 The Secure Anonymised Information Linkage (SAIL) databank - Wales
 Information Services Division – Scotland 
 The Honest Broker Service- Northern Ireland
 
 As well as other sources:
 
 The Clinical Practice Research Datalink 
 The Paediatric Intensive Care Audit Network.
 
 A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions.
 RationalThe project has arisen from the report ‘Overview of Child Deaths in Four UK Countries’ which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems.
 ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.

Burden of smoking in Lithuania: attributable mortality and years of potential life lost.

High mortality rates from smoking related diseases are a significant public health issue in Lithuania. Study aims to estimate the number of smoking attributable deaths (SADs) and years of potential life lost in Lithuania in 2013. Gender, age and disease specific mortality was calculated by applying the smoking attributable fractions (SAFs) to prevalence estimates of current and former smokers among Lithuanian adults aged ≥35 years that are based on the 2005 Lithuanian Health Interview Survey. Mortality data were obtained from the Institute of Hygiene Health Information Centre. Eight years lag was assumed between smoking rates and subsequent mortality. Sensitivity analysis was used to calculate SAFs applying smoking impact ratio method. In 2013, 13.9% of total mortality or 5771 deaths in Lithuania were attributable to smoking (5181 men and 590 women). The two leading causes of SADs were ischaemic heart disease (2861) and lung cancer (1054) that accounted for 67.8% of the smoking attributable mortality. In the same year, smoking accounted for 39 279 years of potential life lost (34 663 years for men and 4615 years for women). Smoking causes a considerable mortality burden in Lithuania, killing nine times more males than females. Therefore reduction of smoking prevalence is an urgent public health need, which calls for implementation of effective and comprehensive tobacco control measures consistent with the World Health Organization Framework Convention on Tobacco Control Articles and Protocols and The Tobacco Products Directive.

Differences in clinician versus patient recording of comorbidities in PROMs

A data request was made from the Health and Social Care Information Centre (HSCIC) regarding patients who had undergone a primary total knee replacement (TKR) at the Norfolk and Norwich Hospital in 2014. In total, 576 patients had received post-operative PROMs questionnaires in 2014. Complete information was available for 195 patients, which forms the basis of this analysis. The patient letters and the pre-operative assessment documentation on our electronic system (Bluespier) were then reviewed. The comorbidities that the clinician felt would apply to that patient were recorded from the list provided in the Oxford Knee Score (OKS) and were then compared with what the patients had recorded. In total, there were 189 additional comorbidities identified from our notes review. Of these, 95 would alter the predicted OKS score in 77 patients. There was a significant change in average predicted OKS score from 33.7 ± 3.9 to 32.3 ± 4.0 (p = 0.02) in the 77 patients who had additional OKS-altering comorbidities. When looking at the case-mix adjustment, the original mean adjustment was -0.83 (± 1.1). After adjusting for clinician-reported comorbidities, there was a significant change in the mean to -1.40 (± 1.4) (p < 0.0001). After the relevant recalculations were carried out, the adjusted average health gain went from 15.254 to 15.907. This is an improvement of 0.653. The small change of ensuring accurate comorbidity recording can have an impact on the adjusted average health gain for a hospital. This is important information: patients report comorbidities differently to clinicians, and often overrate their health. Despite the limitation of this comorbidity data, hospital performance data, which are publically available, are based on this case-mix and comorbidity adjustment. Care clearly needs to be taken in the interpretation of these case mix-adjusted scores. The PROMs (Patient-Reported Outcome Measures) programme, embedded within the NJR, …

Without Library Resources and Services, the Scholarly Activity of Medical Faculty and Residents Would Register a Code Blue

A Review of:&#x0D; Quesenberry, A. C., Oelschlegel, S., Earl, M., Leonard, K., &amp; Vaughn, C. J. (2016). The impact of library resources and services on the scholarly activity of medical faculty and residents. Medical Reference Services Quarterly, 35(3), 259-265. http://dx.doi:org/10.1080/02763869.2016.1189778&#x0D; &#x0D; Abstract&#x0D; &#x0D; Objective – This study aimed to determine the use of three library services – literature search service, article delivery service, and library resources – among medical faculty and residents with regard to scholarly activity.&#x0D; &#x0D; Design – Survey. &#x0D; &#x0D; Setting – Medical Library and Health Information Centre at a large university in the United States of America.&#x0D; &#x0D; Subjects – 65 medical faculty and residents.&#x0D; &#x0D; Methods – The authors sent out 433 invitations to participate in a 23-question survey via an email distribution list. A total of 65 individuals participated, for a response rate of 15%. Questions related to the use of library services for scholarly activity, patterns of information-seeking behaviour, and instructional needs. Comments were allowed on several questions, and a final open-ended question was included.&#x0D; &#x0D; Main Results – All respondents used PubMed at least a few times a year, with 71% selecting it as their first choice to search for articles. Only 20% prioritized Google or Google Scholar above PubMed as the first place to begin a search. The most popular reasons for using library resources were “lectures, papers, research, and patient care” (p.262). The first three of these activities are types of scholarly activity.&#x0D; &#x0D; Of the 65 respondents, 46% published article(s) or book chapter(s). Within this group of authors, 67% of residents undertaking scholarly activity requested a literature review, 100% accessed online material themselves, and 67% requested articles. Faculty placed similar importance on these services, with 71% having requested a literature review, 87% having accessed materials themselves, and 75% having requested articles. Among those respondents who presented posters or papers, there was high use of library services, ranging from 59% of faculty requesting a literature review to 98% of faculty accessing online material themselves.&#x0D; &#x0D; Conclusion – The library is a key resource for faculty and residents undertaking scholarly activity. However, faculty members use the library’s services and resources for publishing articles and book chapters more than residents do. This may be because of “publish or perish” pressure, or because faculty have less time to locate research by themselves. Surveys are useful to ensure the library’s resources and services align with the needs of the user community. Inclusion of free-text comment boxes in the survey allowed users to put a “personal face” (p. 264) to their comments that would have otherwise not been captured.

Acute myocardial infarction hospital admissions and deaths in England: a national follow-back and follow-forward record-linkage study

SummaryBackgroundLittle information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction.MethodsWe used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100 000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions.FindingsAcute myocardial infarction was diagnosed in the first physician encounter in 307 496 (69%) of 446 744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52 374 (12%) admissions, and recorded only as a comorbidity in 86 874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135 950 deaths were recorded as being caused by acute myocardial infarction as the underlying cause of death, of which 66 490 (49%) occurred in patients who were in hospital on the day of death or in the 28 days preceding death. AMI was the primary diagnosis in 32 695 (49%) of these 66 490 patients (27 678 [42%] diagnosed in the first physician encounter and 5017 [8%] in a second or subsequent encounter), was a comorbid diagnosis in 12 118 (18%), and was not mentioned at all in the remaining 21 677 (33%). The most common causes of admission in people who did not have an acute myocardial infarction diagnosis but went on to die of acute myocardial infarction as the underlying cause of death were other circulatory conditions (7566 [35%] of 21 677 deaths), symptomatic diagnoses including non-specific chest pain, dyspnoea and syncope (1368 [6%] deaths), and respiratory disorders (2662 [12%] deaths), mainly pneumonia and chronic obstructive airways disease.InterpretationAs many acute myocardial infarction deaths occurring within 28 days of being in hospital follow a non-acute myocardial infarction admission as follow an acute myocardial infarction admission. These people are often diagnosed with other circulatory disorders or symptoms of circulatory disturbance. Further investigation is needed to establish whether there are symptoms and information that can be used to predict the risk of a fatal acute myocardial infarction in such patients, which can contribute to reducing the mortality burden of acute myocardial infarction.FundingWellcome Trust, Medical Research Council, Public Health England, National Institute for Health Research.

The UK experience of promoting dementia recognition and management in primary care.

BackgroundThe early and timely recognition of dementia syndrome is a policy imperative in many countries. In the UK the achievement of earlier and timelier recognition has been pursued through educational interventions, incentivisation of general practitioners and the promotion of a network of memory clinics.ObjectiveThe effectiveness of education, incentivisation and memory clinic activity are unknown. This article analyses data from different sources to evaluate the impact of these interventions on the incidence and prevalence of dementia, and the diagnostic performance of memory clinics.Material and methodsThree data sources were used: 1) aggregated, anonymised data from a network of general practices using the same electronic medical record software, The Health Information Network (THIN), 2) UK Health & Social Care Information Centre data reports and 3) Responses to Freedom of Information Act requests.ResultsEducational interventions did not appear to change the recorded incidence of dementia syndrome. There was no apparent effect of education, incentives or memory clinic activity on the reported incidence of dementia syndrome between 1997 and 2011 but there were signs of change in the documentation of consultations with people with dementia. There was no clear impact of incentivisation and memory clinic activity in prevalence data. Memory clinics are seeing more patients but fewer are being diagnosed with dementia.ConclusionIt is not clear why there has been no upturn in documented incidence or prevalence of dementia syndrome despite substantial efforts and this requires further investigation to guide policy changes. The performance of memory clinics also needs further study.

Incidence of venous thromboembolism in care homes: a prospective cohort study.

Care home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear. To determine the incidence of VTE in care homes. Observational cohort study of 45 care homes in Birmingham and Oxford, UK. A consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.) RESULTS: There were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE. The incidence of VTE in care homes in this study (0.71-2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed.

Primary care diabetes prescribing rates: latest analysis shows continued rise in volume and cost

Primary care diabetes prescribing rates: latest analysis shows continued rise in volume and cost

Time series analysis of weekly influenza-like illness rate using a one-year period of factors in random forest regression.

Influenza, a disease caused by a respiratory virus, sickened over 5,043,127 citizens in Shenzhen, China, from January 2014 to April 2016. An accurate forecasting of outbreaks of influenza-like illness (ILI, here we refer to ILI as the upper respiratory infection) could facilitate public health officials to suggest public health actions earlier. In this study, a random forest regression constructed with a one-year period of factors was adopted to forecast the weekly ILI rate using the clinical data from Shenzhen Health Information Center. The following conclusions were drawn based on this method: i) Compared to the predication with 52 (one-year) history observations, the accuracy of the predication was improved by adding another 52 first-order difference variables: mean absolute percentage error (MAPE) decreased from 5.04% to 4.35% and mean squared error (MSE) decreased from 2.85E-04 to 1.97E-04. ii) The variables with the first-order difference seemed more significant than the original history observations during the predication. In addition, both the recent observations and the later observations seemed important in the predicating procedure. iii) Analysis using the Pearson correlation concluded that weather conditions, the influence of which could have been implied by history observations and seemed insignificant for the predication, showed correlation to the weekly average temperature and maximum temperature. The correlation coefficients were -0.3656 and -0.3583, respectively.

사회적 환경과 학교의 위치가 고등학생의 음주행동에 미치는 영향 : 유해업소출입경험의 매개효과

Objectives: This study was conducted in order to explore the predictive model of the experience of harmful shops and drinking in high school students. Method: The survey was conducted using a self-administered questionnaire method online via the homepage of the education ministry’s student health information center. Participants were 956 high school students from 47 schools in Korea. The collected data were processed using the Stata and Amos program. Results: About 57% and 61% said they had been to game places and entertainment places, respectively. In the case of drinking behavior, boys rather than girls, students who were not stratified with school life, living with a single parent, if their school and home were located downtown or near an entertainment place, who have experiences with game facilities were more likely to drink frequently. Conclusion: These results suggest that an educational approach should be developed by tailored conditions to prevent the access to harmful shops and drinking behavior.

Pedestrian Mortality Trends In Children Over Four Decades In Transitional Lithuania

The aim of the study was to examine the long-term trends in pedestrian mortality for children (aged 0 to 14 years) and young people (aged 15 to 19 years) over four decades in transitional Lithuania. Methods. Road traffic fatality data were obtained from Statistics Lithuania and the Archives of Health Information Centre. Trends were analysed by linear regression using “Independence” as a slopechanging intervention in 1991 and population as a further explanatory factor in structural time series models. Results. The impact of the interventions, along with the reforms and changes related with the Independence, on pedestrian fatality trends in our time series model was found highly statistically significant for children 0 to 14 years (p&lt;0.001) and still significant for young people 15 to 19 years (p&lt;0.05). No significant impact on the trend of road traffic deaths was found for the “control-groups” of non-pedestrian road users in the age group 0 to 14 years and adult pedestrians (over 19 years of age). For the age group 15 to 19 years the effect of reforms was also significant for non-pedestrians (p&lt;0.05). These results indicate that the effect of measures and changes used in the post-independence period was more specific in children that participated in road traffic as pedestrians than in adult pedestrians, or in nonpedestrian road users. Conclusions. Pedestrian deaths in Lithuania fell significantly in the age groups 0-14 and 15-19 years. A declining trend was found in road traffic fatalities and in pedestrian deaths in transitional Lithuania in the post-independence period. Socioeconomic and political transformations, systematic reforms in healthcare along with sustainable preventive measures may have contributed to this decrease. Targeted road safety measures were road traffic regulations, pedestrian education and environmentally based prevention measures. As child pedestrians are the most vulnerable group of road users, continued road safety education and promotion are recommended in order to maintain this trend, and to involve adult pedestrians in this development.

PCV144 - Novel Oral Anticoagulants in the UK and France: Comparative Assessment of Costs of Prescriptions Dispensed in the Non-Hospital Setting

To assess and compare the expenditure on novel oral anticoagulants (NOACs) in the non-hospital setting, in England and France. Non-systematic review of publically available health authority websites and peer review journals. Prescription costs data, from 2012-2015, were obtained and analyzed for England from the Health and Social Care Information Centre Prescription Cost Analysis for England reports, and for France from the Assurance Maladie Medic’AM reports. In the UK, clinical objections raised by prescribers have limited NOAC uptake in the past; however, between 2012-2015 the costs associated to non-hospital dispensed prescriptions for the three main NOACs, rivaroxaban, apixaban and dabigatran, increased from £3,7M in 2012 to £144,2M in 2015, showing a considerable increase in expenditure, mostly due to the increase in rivaroxaban and apixaban prescription. This can be partly attributed to the issue of NICE guidance favoring the use of NOACs in non-valvular atrial fibrillation and efforts to implement NICE recommendations. Similar results have been observed in France, where costs associated to NOAC prescriptions dispensed in the non-hospital setting have increased from €56.3M in 2012 to €309,8M in 2015. In response to increasing NOAC prescription, the ANSM and Assurance Maladie consider there is a need for increased vigilance in their use. These findings highlight the considerable increase in NOAC prescriptions and costs in both England and France, and should inform future policy efforts to encourage adequate use of NOACs in order to control increasing expenditure. Between 2012 and 2015, there was a considerable increase in NOAC drug expenditures from prescriptions dispensed in the non-hospital setting, in both England and France, which suggests that policies aimed at incentivizing NOAC prescriptions have been effective, but should further factor in the increasing economic impact of these treatments.

Ability of HIV Advocacy to Modify Behavioral Norms and Treatment Impact: A Systematic Review

Background. HIV advocacy programs are partly responsible for the global community’s success in reducing the burden of HIV. The rising wave of the global burden of noncommunicable diseases (NCDs) has prompted the World Health Organization to espouse NCD advocacy efforts as a possible preventive strategy. HIV and NCDs share some similarities in their chronicity and risky behaviors, which are their associated etiology. Therefore, pooled evidence on the effectiveness of HIV advocacy programs and ideas shared could be replicated and applied during the conceptualization of NCD advocacy programs. Such evidence, however, has not been systematically reviewed to address the effectiveness of HIV advocacy programs, particularly programs that aimed at changing public behaviors deemed as risk factors. Objectives. To determine the effectiveness of HIV advocacy programs and draw lessons from those that are effective to strengthen future noncommunicable disease advocacy programs. Search methods. We searched for evidence regarding the effectiveness of HIV advocacy programs in medical databases: PubMed, The Cumulative Index to Nursing and Allied Health Literature Plus, Educational Resources and Information Center, and Web of Science, with articles dated from 1994 to 2014. Search criteria. The review protocol was registered before this review. The inclusion criteria were studies on advocacy programs or interventions. We selected studies with the following designs: randomized controlled design studies, pre–post intervention studies, cohorts and other longitudinal studies, quasi-experimental design studies, and cross-sectional studies that reported changes in outcome variables of interest following advocacy programs. We constructed Boolean search terms and used them in PubMed as well as other databases, in line with a population, intervention, comparator, and outcome question. The flow of evidence search and reporting followed the standard Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data collection and analysis. We selected 2 outcome variables (i.e., changing social norms and a change in impact) out of 6 key outcomes of advocacy interventions. We assessed the risk of bias for all selected studies by using the Cochrane risk-of-bias tool for randomized studies and using the Risk of Bias for Nonrandomized Observational Studies for observational studies. We did not grade the collective quality of evidence because of differences between the studies, with regard to methods, study designs, and context. Moreover, we could not carry out meta-analyses because of heterogeneity and the diverse study designs; thus, we used a narrative synthesis to report the findings. Main results. A total of 25 studies were eligible, of the 1463 studies retrieved from selected databases. Twenty-two of the studies indicated a shift in social norms as a result of HIV advocacy programs, and 3 indicated a change in impact. We drew 6 lessons from these programs that may be useful for noncommunicable disease advocacy: (1) involving at-risk populations in advocacy programs, (2) working with laypersons and community members, (3) working with peer advocates and activists, (4) targeting specific age groups and asking support from celebrities, (5) targeting several, but specific, risk factors, and (6) using an evidence-based approach through formative research. Author conclusions. HIV advocacy programs have been effective in shifting social norms and facilitating a change in impact. Public health implications. The lessons learned from these effective programs could be used to improve the design and implementation of future noncommunicable disease advocacy programs.

The Care Programme Approach, sexual violence and clinical practice in mental health

IntroductionResearch in Sexual Assault Referral Centres has shown that 40% of those attending are known to mental health services. The question we posed in this study was to what extent do mental health services know about this group? This was a pertinent question to ask as in 2008 the Department of Health (DH) amended the Care Programme Approach (CPA) to include a question on sexual abuse/violence as part of the overall assessment. AimsTo assess the extent to which Mental health Trusts were implementing DH guidance on the CPA in relation to assessment of sexual violence and abuse. Method1. Freedom of Information (FOI) requests were sent to all Mental Health Trusts. 2. The Information base at the Health and Social Care Information Centre (HSCIC) was interrogated as Trusts can make returns on this CPA question, however it is not mandatory. Results1. The FOI requests revealed that: only 66% of staff were trained to 'ask the question' (range 35–100%) and only five out of 53 Trusts audited whether the question was asked. 2. The HSCIC data revealed that in 2014/15 there were 335,727 people in the CPA in England and there was a record in only 17% of cases of the question being asked. Over half (57%) of the 69 providers who did not submit any information on the indicator in 2014/15 as well as, for those 30 providers who did submit information, the data field was only 41% complete. ConclusionsThe impetus for ‘asking the question’ first established in 2008 with the establishment of eight pilot training programmes, has been lost. It is clear that Trusts are not training adequate number of staff nor are they returning useable data to HSCIC. If 40% of people attending SARCs are known to mental health services we suspect that few staff in mental health trusts known much about such a referral. Research shows convincingly that sexual violence and abuse plays a clear role in the aetiology of mental health disorders. A history of such violence/abuse should be always established (or otherwise).

Diagnosis and management of angina for the cardiac nurse

The burden of treating stable angina is vast, as it is estimated that almost 2 million people currently have or have had angina in the UK ( Health and Social Care Information Centre (HSCIC), 2006 ). Angina is the main symptom of myocardial ischaemia, usually caused by atherosclerotic obstructive coronary artery disease, restricting bloodflow and therefore oxygen delivery to the heart muscle ( National Institute for Health and Care Excellence (NICE), 2011 ). Characteristic features of stable angina include tightness or heaviness across the chest, which can radiate to the left arm, neck, jaw and back. However, it is important to be aware that some people present with atypical symptoms. A diagnosis of stable angina can be based on clinical assessment alone or with the addition of diagnostic testing. Diagnosic tests used in this instance can include: exercise testing, computerised tomography (CT), myocardial perfusion scanning and stress echocardiography, in addition to blood tests and electrocardiogram which all patients will undergo. Management of angina includes medical therapy, the aim of which is to help reduce symptoms and prevent cardiovascular events such as myocardial infarction and stroke ( Montalescot et al, 2013 ). Guidelines on stable angina by NICE (2011) and the European Society of Cardiology (ESC) ( Montalescot et al, 2013 ) provide us with recommendations on which medications should be prescribed. Lifestyle changes are a key aspect of angina management: namely in the areas of diet, exercise, smoking, diabetes, hypertension and psychological issues.

Tackling obesity, physical activity levels and dietary intake: the extent of the problem

Tackling obesity, physical activity levels and dietary intake: the extent of the problem

Articles Published and Downloaded by Public Health Scientists: Analysis of Data From the CDC Public Health Library, 2011-2013.

To describe scientific information usage and publication patterns of the Centers for Disease Control and Prevention (CDC) Public Health Library and Information Center patrons. Administratively collected patron usage data and aggregate data on CDC-authored publications from the CDC Library for 3 consecutive years were analyzed. The CDC Public Health Library and Information Center, which serves CDC employees nationally and internationally. Internal patrons and external users of the CDC Library. Three-year trends in full-text article publication and downloads including most common journals used for each purpose, systematic literature searches requested and completed, and subscriptions to a weekly public health current literature awareness service. From 2011 to 2013, CDC scientists published a total of 7718 articles in the peer-reviewed literature. During the same period, article downloads from the CDC Library increased 25% to more than 1.1 million, completed requests for reviews of the scientific literature increased by 34%, and electronic subscriptions to literature compilation services increased by 23%. CDC's scientific output and information use via the CDC Library are both increasing. Researchers and field staff are making greater use of literature review services and other customized information content delivery. Virtual public health library access is an increasingly important resource for the scientific practice of public health.