Important Public Health Message Research Articles

Empirical facts about Erythritol’s effects on whole body systems: A systematic Review

Background: There is an important public health message concerning obesity, diabetes, and the reduction of sugar consumption. Erythritol seems like the sweetener of choice but contrasting evidence exists so there is therefore a pertinent need to establish rigorous facts to ensure Erythritol ‘dosage’ is correct and to improve the nation’s health. Objectives: To plot the landscape by assessing all robust research to discover ‘safe erythritol use’, ‘acceptable’ side effects, and most importantly the whole ‘body systems’ impact and interactions. Also, to establish whether 25g/day could be safely doubled, maximum laxative thresholds, and unique Erythritol characteristics. Methods: All knowledge type/outcomes and grey data were eligible and reported according to ‘body system’s using EQUATOR and PRISMA guidelines. Bias was kept to a minimum via BEME rigor checklists. Results: 256 papers were included in the review. ‘Safe use’ Erythritol amounts and maximum thresholds were established. No disadvantages of Erythritol were found providing thresholds were not exceeded. Erythritol has unique properties which produced important new findings: Erythritol is metabolised differently for ‘Diabetic versus non-diabetic’, and ‘Early-stage versus late-stage diabetic’; In the ‘obese versus lean’; and if taken within ‘Solids versus liquids’. Conclusions: New knowledge on safe Erythritol ‘dosage’, maximally effective period, and body systems were gained which affect and inform the nation’s weight and health choices.

Five common misconceptions regarding flattening-the-curve of COVID-19.

In the fight against COVID-19 pandemic, the phrase “Flattening the curve” (FTC) has become a rallying cry, popularized by government leaders and journalist in the news and on the social media. FTC is a succinct way of communicating an important public health message that physical distancing, mask-wearing and other public health measures will decrease the peak number of cases and prevent the healthcare system from being overwhelmed. However, while the message of FTC is right in the sense that limiting transmission will reduce the peak number of cases, some visualizations used to illustrate its effect are incorrect from an infectious disease modelling point of view. The misconceptions are misinterpretations of flattened curves, the effect of FTC on the duration of the pandemic, the dynamics of the curve to be flattened, and the overestimation of the importance of FTC.

How War-Framing Effects Differ Depending on Publics’ Conspiracy Levels: Communicating the COVID-19 Vaccination

Public conspiracy beliefs prevent various social institutions including governments from communicating effectively. Fostering effective communication with high conspiracy belief individuals, who often disregard important public health messages, is crucial. This study investigated whether war framing could be used to effectively communicate with highly suspicious individuals. Specifically, it used an online experiment with 398 Korean citizens to examine how war-framing effects vary based on individual differences in general conspiracy and government-related conspiracy beliefs in the COVID-19 vaccination context. The results generally showed that literal messages were more effective for low conspiracy belief individuals while war-framed messages were more effective for those with high conspiracy beliefs. Additional analysis indicated that general conspiracy and government-related conspiracy beliefs were negatively associated with individuals’ vaccination attitudes and intentions. This study concludes by discussing the practical implications of its findings for health communication involving highly suspicious individuals.

Breast cancer survivors’ typhoid vaccine responses: Chemotherapy, obesity, and fitness make a difference

PurposeTo investigate breast cancer survivors’ inflammatory responses to typhoid vaccine as a window into their innate immune response to novel pathogens. MethodsThis double-blind crossover trial randomized 158 breast cancer survivors to either the vaccine/saline placebo or the placebo/vaccine sequence. The relative contributions of age, cardiorespiratory fitness (VO2peak), type of cancer treatment, central obesity, and depression to interleukin (IL)-6, IL-1 receptor antagonist (IL-1Ra), and WBC vaccine responses were assessed pre-injection and 1.5, 3, 4.5, 6, and 7.5 h post-injection. ResultsThe vaccine produced larger IL-6, IL-1Ra, and WBC responses than placebo, ps < 0.0001. Prior chemotherapy, higher central obesity, and lower VO2peak were associated with smaller vaccine responses after controlling for baseline inflammation. Vaccine response was summarized by the percent increase in area under the curve (IL-6, WBC) or average post-injection mean (IL-1Ra) for vaccine relative to placebo. Women who received chemotherapy had smaller vaccine responses than women who did not for both IL-6 (44% vs 78%, p <.001) and WBC (26% vs 40%, p <.001); IL-1ra response was not significantly moderated by chemotherapy. Women whose central adiposity was one standard deviation above the mean had smaller vaccine responses than women with average adiposity for IL-6 (33% vs 54%, p <.001), WBC (20% vs 30%, p <.001), and IL-1Ra (2.0% vs 3.2%, p <.001). Women with an average level of VO2peak had smaller vaccine responses than women whose VO2peak was one standard deviation above the mean for IL-6 (54% vs 73%, p <.001), WBC (30% vs 40%, p <.001), and IL-1Ra (3.2% vs. 4.1%, p = 0.01). Age and depression did not significantly moderate vaccine responses. ConclusionsThis study provided novel data on chemotherapy’s longer-term adverse immune consequences. The data also have an important public health message: even relatively low levels of fitness can benefit the innate immune response to a vaccine.

Estimating excess visual loss from neovascular age-related macular degeneration in the UK during the COVID-19 pandemic: a retrospective clinical audit and simulation model

ObjectivesTo report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at 1 year.DesignRetrospective clinical...

3.C. Workshop: COVID-19 – Are students’ lives turned upside down? Findings from the C19 ISWS study

Abstract The SARS-CoV-2 outbreak and the corresponding COVID-19 pandemic has had and continues to have a significant impact on the health and wellbeing of the general population globally. University students are in a unique position during the COVID-19 pandemic as they are confronted with substantial changes and restrictions, both at governmental and university-level. Stark changes to lifestyle include changes in social and academic life. In order to understand and investigate the impact of the COVID-19 pandemic on student health and well-being, the COVID-19 International Student Well-Being Study (C19 ISWS) was initiated early on in April 2020. Led by researchers at the University of Antwerp, Belgium, a survey questionnaire and protocol was written. Within a few weeks, researchers from 166 high education institutions in 26 different countries had agreed to run the survey in their respective institutions and data was collected from May- July 2020. Up until now, researchers involved in the C19 ISWS consortia have not met and thus far, only a limited amount of researchers have shared their findings. The European Public Health Conference provides a unique opportunity for researchers across countries to share and discuss key findings of the survey, including important public health messages that can be derived from the results of the survey. Presentations on study results of the C19 ISWS will be given by five presenters. Firstly, Prof. Sarah Van De Velde, principal investigator of the study, will provide an overview of the C19 ISWS study design, measures and procedures. Following this introductory talk, four presenters will provide insight into findings of the study at the international level as well as country-level from different regions with varying circumstances during the pandemic (Greece, Russia and Germany). Presentations will be scheduled for seven minutes with three minutes question, followed by a 10-minute discussion at the end. This will allow the audience time to interact with the findings. This works thus aims to provide an exchange and presentation on international as well as country-level findings of the C19 ISWS. Given the shared interest in student health and wellbeing, the joint workshop will provide a further opportunity for researchers to connect. In summary, the objectives of the workshop are: Share and discuss findings of the COVID-19 International Student Well-Being Study Discuss implications of findings for student population internationally including possible measures of actions at individual, community-and structural level Connect researchers and practitioners interested in student health and well-being across Europe and internationally This workshop is aimed at researchers and practitioners with an interest in student health and wellbeing, particularly students in higher education. If possible, a list of attendees and contact details will be collected with participant's agreement and shared amongst all attendees of the workshop. Key messages The COVID-19 International Student Well-Being Study (C19 ISWS) investigated the impact of the pandemic on students’ health, including students of 166 higher education institutions in 26 countries. Findings at country-and international level will be shared and discussed and implications for student’s health and wellbeing will be drawn.

Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study.

BackgroundOver the past decade, there has been an increasing secular trend in the number of studies on social media and health.ObjectiveThe purpose of this cross-sectional study was to examine the content and characteristics of TikTok videos that are related to an important aspect of community mitigation—the use of masks as a method for interrupting the transmission of SARS-CoV-2.MethodsIn total, 100 trending videos with the hashtag #WearAMask (ie, a campaign on TikTok), along with 32 videos that were posted by the World Health Organization (WHO) and involved masks in any way (ie, all related WHO videos at the time of this study), were included in our sample. We collected the metadata of each post, and created content categories based on fact sheets that were provided by the WHO and the US Centers for Disease Control and Prevention. We used these fact sheets to code the characteristics of mask use.ResultsVideos that were posted on TikTok and had the hashtag #WearAMask garnered almost 500 million views, and videos that were posted by the WHO garnered almost 57 million views. Although the ratio of the number of trending #WearAMask videos to the number of WHO videos was around 3:1, the #WearAMask videos received almost 10 times as many cumulative views as the WHO videos. In total, 68% (68/100) of the trending #WearAMask videos involved humor and garnered over 355 million cumulative views. However, only 9% (3/32) of the WHO videos involved humor. Furthermore, 27% (27/100) of the trending #WearAMask videos involved dance and garnered over 130 million cumulative views, whereas none of the WHO videos involved dance.ConclusionsThis study is one of the first to describe how TikTok is being used to mitigate the community spread of COVID-19 by promoting mask use. Due to the platform’s incredible reach, TikTok has great potential in conveying important public health messages to various segments of the population.

COVID-19 on TikTok: harnessing an emerging social media platform to convey important public health messages.

TikTok is a popular social media platform, especially among those who are 13-24 years of age. The purpose of this cross-sectional study was to describe the content of COVID-19 material on TikTok. A total of 100 videos posted under the hashtag #Coronavirus were included in this study along with all (n=17) posts uploaded by the World Health Organization (WHO). Overall, these videos were viewed 1,194,081,700 times. The most commonly cited topics included anxiety (14.5%) with more than 190.6 million views and quarantine (10.3%) with 106.6 million views. Fewer than 10% of videos mentioned how the virus is transmitted, symptoms, and prevention. WHO videos more often focused on viral transmission and symptoms but covered these topics in fewer than 10% of the videos. Although research suggests that cases of COVID-19 may be less severe in those under 18 years of age, social distancing remains paramount due to the possibility of transmission even in those with minimal or no symptoms. For young adults in particular, the WHO suggests staying connected through social media and making every attempt to stay positive. TikTok has the potential, not only to convey important health information, but to address these aspects of the COVID-19 pandemic as well.

Age-related Macular Degeneration: Nutrition, Genes and Deep Learning—The LXXVI Edward Jackson Memorial Lecture

To evaluate the importance of nutritional supplements, dietary pattern, and genetic associations in age-related macular degeneration (AMD); and to discuss the technique of artificial intelligence/deep learning to potentially enhance research in detecting and classifying AMD. Retrospective literature review. To review the studies of both prospective and retrospective (post hoc) analyses of nutrition, genetic variants, and deep learning in AMD in both the Age-Related Eye Disease Study (AREDS) and AREDS2. In addition to demonstrating the beneficial effects of the AREDS and AREDS2 supplements of antioxidant vitamins and zinc (plus copper) for reducing the risk of progression to late AMD, these 2 studies also confirmed the importance of high adherence to Mediterranean diet in reducing progression of AMD in persons with varying severity of disease. In persons with the protective genetic alleles of complement factor H (CFH), the Mediterranean diet had further beneficial effect. However, despite the genetic association with AMD progression, prediction models found genetic information added little to the high predictive value of baseline severity of AMD for disease progression. The technique of deep learning, an arm of artificial intelligence, using color fundus photographs from AREDS/AREDS2 was superior in some cases and noninferior in others to clinical human grading (retinal specialists) and to the gold standard of the certified reading center graders. Counseling individuals affected with AMD regarding the use of the AREDS2 supplements and the beneficial association of the Mediterranean diet is an important public health message. Although genetic testing is important in research, it is not recommended for prediction of disease or to guide therapies and/or dietary interventions in AMD. Techniques in deep learning hold great promise, but further prospective research is required to validate the use of this technique to provide improvement in accuracy and sensitivity/specificity in clinical research and medical management of patients with AMD.

Adult breakfast habits and nutritional status: A household based cross-sectional study in Zhejiang Province, China.

Although Dietary Guidelines for Chinese Residents offers advice for breakfast in China, current breakfast consumption habits are unclear. The aim of this study was to describe the frequency of breakfast consumption among adults and explore its associations with daily food consumption and daily nutrient intake. A stratified cluster sampling technique was employed in this cross-sectional study. Demographic characteristics, breakfast consumption, and daily food and nutrient intake were investigated. Dietary data were collected for 3251 adult residents through interviews. We determined that residents with an annual income of <CN¥10000 were the group with the highest rate of breakfast consumption. Among adults living at home, those who were retired had the highest proportion of breakfast eaters (92.1%), whereas among adults not living at home, commercial services and production personnel had the highest proportion of breakfast eaters (83.8%). Residents who never ate breakfast had a lower daily intake of rice, dark-colored vegetables, pork, poultry, and fish and shrimp and a higher daily intake of bean products and instant foods (p<0.05). Residents who never ate breakfast had a higher daily intake of energy, fat, and carbohydrates, and a lower intake of protein, retinol, vitamins A and C, carotene, Ca, P, K, Mg, Zn, Se, and Mn (p<0.05). Breakfast skipping may influence the daily intake of nutrients. A simple and important public health message should be delivered to target populations.

O13 Pregnancy vitamin D supplementation leads to greater offspring bone mineral density at 4 years: the MAVIDOS randomised placebo controlled trial

Abstract Background Observational studies have demonstrated associations between maternal gestational vitamin D status and offspring bone health. We have recently shown, in a randomised controlled trial, that pregnancy vitamin D supplementation leads to improved offspring bone mass at birth amongst winter deliveries (when background 25(OH)-vitamin D levels are lowest). In the present analysis, we aimed to evaluate whether the beneficial effect of pregnancy vitamin D supplementation on neonatal bone mass is sustained into early childhood, with bone indices assessed at age 4 years in a subset of participants of the MAVIDOS trial. Methods Pregnant women were randomised in Southampton, Oxford and Sheffield, in a double-blind design, to 1000 IU/day cholecalciferol or matched placebo from 14 weeks’ gestation to birth. At 4 years of age (Southampton participants only, n = 723 births), offspring assessments included anthropometry, whole-body dual-energy x-ray absorptiometry (DXA) [Hologic Horizon, yielding whole body less head (WBLH) bone mineral content (BMC), bone mineral density (BMD), bone area (BA) and lean mass (LM)], and a maternal questionnaire. Linear regression was used to estimate the mean difference (represented by β) in outcomes between the two randomisation arms, adjusted for sex and age at DXA. Further models were additionally adjusted for gestational age, maternal BMI, and child’s sedentary time. All outcomes were standardised to a standard deviation scale, for ease of comparison. Full ethics and MHRA approvals were granted. Results 564 children attended the 4-year visit; 452 had a useable DXA with minimal movement artefact. Maternal pregnancy vitamin D supplementation led to greater offspring indices of bone mass compared with placebo, irrespective of season. For example, WBLH BMD at age 4 years was greater in the offspring of supplemented mothers [β = 0.18 SD (95%CI: 0.00, 0.35), p = 0.047]; there was also evidence of greater LM in the intervention group [β = 0.15 SD (95%CI: -0.02, 0.31), p = 0.081]. In fully adjusted models associations were consistent for lumbar spine indices and for BA and BMC. In keeping with the offspring findings, maternal vitamin D supplementation led to significantly higher maternal plasma 25(OH)D concentrations in late pregnancy (34 weeks’ gestation): placebo group (median(IQR)): 42.4 nmol/l (23.3, 56.4); vitamin D group: 67.4 nmol/l (56.2, 80.3); p &amp;lt; 0.001. Conclusion This is the first ever demonstration in a large placebo-controlled, double-blind randomised controlled trial that maternal pregnancy vitamin D supplementation leads to improved bone and lean mass in children. Our findings suggest that maternal cholecalciferol supplementation may have lasting benefits for offspring musculoskeletal health and thus represent an important public health message. This work was supported by grants from Versus Arthritis 17702, Medical Research Council (MRC #405050259; #U105960371), Bupa Foundation, NIHR Southampton Biomedical Research Centre (BRC), University of Southampton, and NIHR Oxford BRC, University of Oxford. EC was supported by the Wellcome Trust (#201268/Z/16/Z). Disclosures E.M. Curtis None. R.J. Moon None. S. D'Angelo None. S.R. Crozier None. N.J. Bishop None. S. Gopal- Kothandapani None. S. Kennedy None. A.T. Papageorghiou None. R. Fraser None. S.V. Gandhi None. I. Schoenmakers None. A. Prentice None. H.M. Inskip None. K.M. Godfrey None. K. Javaid None. R. Eastell None. C. Cooper None. N.C. Harvey None.

New Zealand adult ocular trauma study: A 10-year national review of 332 418 cases of ocular injury in adults aged 18 to 99 years.

Ocular injury is a common, preventable cause of temporary and permanent disability. The current study evaluates the nationwide incidence, demographics and visual outcomes of adults with ocular injury in New Zealand. Nationwide retrospective review. New Zealanders aged 18-99 years from 2007 to 2016 with ocular injury requiring assessment by a registered medical practitioner. New Zealand national and regional datasets were used to evaluate population-level statistics over a 10-year period. Visual and clinical outcome data were assessed using a random sample of 150 patients from a tertiary hospital. Annual incidence, aetiology, demographics, injury location, visual outcomes, protective eyewear use, surgical intervention and follow-up. A total of 332 418 adult eye injuries were recorded nationally. The annual incidence of eye injury was 1007/100 000 population/year. Patients were predominantly male (76.1%), of New Zealand-European ethnicity (74.6%) and aged between 20 and 29 years (21.1%). The most common mechanism of injury was "struck by object" (55.4%). Injuries occurred most commonly at home (48.4%), followed by commercial (15%) and industrial locations (13.8%). Injuries were more common in rural regions (P < .001). Protective eyewear use was reported in 6% of cases (n = 9, 95% confidence interval = 3.2-11.0). Most ocular injuries were managed exclusively in primary care (70.5%). Adults with the highest risk of ocular injury are rural males aged 20 to 29 years. Protective eyewear use is uncommon in adults presenting with ocular injury and the majority of injuries are managed in primary care. Promotion of appropriate injury prevention strategies is an important public health message.

Child Maltreatment: Brief Communication

Child maltreatment has serious consequences, including increasing an individual's risk of physical and mental health problems across their life course. Objective: Here we show that there is an important public health message to focus, not only on approaches that prevent or detect childhood maltreatment, but also to explore methods of prevention and detection of mental ill health. Results: The study Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis (2019) showed that all different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76–3.64], physical abuse (OR 2.52, 95% CI 2.09–3.04) and emotional abuse (OR 2.49, 95% CI 1.64–3.77) were associated with two- to three-fold increased risk for suicide attempts. Conclusion: It is important to highlight emotional violence may actually be more powerful than physical and sexual abuse in its impact on adolescent suicide behaviors in low- and middle-income countries. Keywords: Child Maltreatment; Mental Health; Prevention.

The drugs don't work: evaluation of educational theatre to gauge and influence public opinion on antimicrobial resistance

Increased public awareness of antimicrobial resistance (AMR) is a key component of effective antimicrobial stewardship strategies. Educational theatre combined with an expert panel was used to engage the public about AMR through delivery of a play entitled 'The drugs don't work'. Audience knowledge and understanding of AMR were measured by pre- and post-play questionnaires. Performance of the play and discussion with the expert panel significantly improved audience knowledge and understanding of AMR, including antibiotic misuse and prescribing. Educational theatre provides a positive learning experience and is an innovative method of public engagement to disseminate important public health messages.

An update on chemical eye burns.

Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as keychallenges. Education and prevention are therefore importantpublic health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherencerates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.

New Zealand childhood ocular trauma study: Analysis of 75 601 cases of ocular injury from 2007 to 2016.

Childhood ocular injury is a common, preventable cause of potentially severe permanent disability. This study evaluates the nationwide incidence, demographics and visual outcomes of children with ocular injury in New Zealand. Nationwide retrospective review. All children in New Zealand aged 0 to 17 years from 2007 to 2016 with ocular injury requiring assessment by a medical practitioner. New Zealand national and regional datasets were used to evaluate population-level statistics for ocular injury over a 10-year period. Visual and clinical outcome data were assessed using a randomized sample of 150 patients. Annual incidence, aetiology, demographics, injury location, visual outcomes, protective eyewear use, surgical intervention and follow-up. A national total of 75 601 cases were included with a mean incidence of 719/100 000 children/year. Cases were predominantly male (63.2%) and of New Zealand-European ethnicity (60.8%), aged 0 to 4 years (30.66%). Injury cause was most commonly "struck by object" (53.7%) and occurred in the home (50.9%). Tertiary hospital assessment and treatment was required in 17.7% where final visual acuity of 6/12 or worse was noted in 19.7% and protective eyewear use was reported in 2.7%. Maori and Pacific ethnicities were associated with higher rates of permanent visual impairment. Children with the highest risk of ocular injury are males aged 0 to 4 years. Children of Maori or Pacific Island ethnicity and aged 15 to 17 years have the highest risk of ocular injury resulting in permanent visual impairment. Protective eyewear use is uncommon in children presenting with ocular injury. Promotion of appropriate injury prevention strategies is an important public health message.

Prevalence and Causes of Cognitive Impairment and Dementia in a Population-Based Cohort From Northern Portugal.

Vascular disease may play an important role in the epidemiology of dementia in countries with high stroke incidence, such as Portugal. To assess the prevalence and etiology of cognitive impairment in a population-based cohort from Portugal. Individuals ≥55 years (n = 730) from the EPIPorto cohort were assessed using the Mini-Mental State Examination and the Montreal Cognitive Assessment. Those scoring below the age-/education-adjusted cutoff points were further evaluated to identify dementia or mild cognitive impairment (MCI) and to define its most common causes. Thirty-six cases of MCI/dementia were identified, corresponding to adjusted prevalences of 4.1% for MCI and 1.3% for dementia. The most common cause of MCI/dementia was vascular (52.8%), followed by Alzheimer's disease (36.1%). These findings highlight the importance of vascular cognitive impairment in the epidemiology of dementia in Portugal and carry an important public health message regarding its prevention and management, possibly extending to other countries with a high-stroke burden.

When is a medicine unwanted, how is it disposed, and how might safe disposal be promoted? Insights from the Australian population.

Objective The aim of the present study was to explore disposal practices of unwanted medicines in a representative sample of Australian adults, compare this with previous household waste surveys and explore awareness of the National Return and Disposal of Unwanted Medicines (RUM) Project. Methods A 10-min online survey was developed, piloted and conducted with an existing research panel of adult individuals. Survey questions recorded demographics, the presence of unwanted medicines in the home, medicine disposal practices and concerns about unwanted medicines. Descriptive statistical analyses and rank-ordered logit regression were conducted. Results Sixty per cent of 4302 respondents reported having unwanted medicines in their household. Medicines were primarily kept just in case they were needed again and one-third of these medicines were expired. Two-thirds of respondents disposed of medicines with the household garbage and approximately one-quarter poured medicines down the drain. Only 17.6% of respondents had heard of the RUM Project, although, once informed, 91.7% stated that they would use it. Respondents ranked the risk of unintended ingestion as the most important public health message for future social marketing campaigns. Conclusions Respondents were largely unaware of the RUM Project, yet were willing to use it once informed. Limited awareness could lead to environmental or public health risks, and targeted information campaigns are needed. What is known about the topic? There is a growing international evidence base on how people dispose of unwanted medicines and the negative consequences, particularly the environmental effects of inappropriate disposal. Although insight into variation in disposal methods is increasing, knowledge of how people perceive risks and awareness of inappropriate disposal methods is more limited. What does this paper add? This study provides evidence of inappropriate medicines disposal and potential stockpiling of medicines in Australian households that could contribute to environmental and/or public health risks. It also reveals possible trends towards a higher frequency of inappropriate disposal practices in the Australian context. Insights into respondents' perceptions of associated risks and awareness of a national scheme for appropriate disposal of medicines have not previously been reported. What are the implications for practitioners? The findings of the present study provide important insights for all health professionals as stakeholders in the quality use of medicines. It is important for those health professionals who assist consumers to manage their medicines to have strategies in place that routinely identify potential stockpiling and inform consumers about appropriate methods of medicines disposal. Although the findings of this study are specific to the Australian context, they may usefully inform policy, public health campaigns and the individual practices of health professionals and other stakeholders in promoting the quality use of medicines nationally and internationally.

Patient and public understanding and knowledge of antimicrobial resistance and stewardship in a UK hospital: should public campaigns change focus?

The rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies. A panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room. One hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%). We describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic.

Dementia services in primary care

What is good for your heart is good for the brain, and promoting this important public health message in GP practices is one of the best ways to reduce the number of people living with dementia in the future, says George McNamara