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Background Policy and social change have increased women's participation in the labour market and their opportunity to combine paid work with family care. We analyse whether a specific combination of employment and domestic duties over the life course are associated with variations in English and French women's health, focusing on two birth cohorts. Methods We used sequence analysis to group women in English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe, according to their work and family histories. Using ordered logistic regression, we tested for group differences in later self-reported health and depressive symptoms, while controlling for a range of adult socio-economic circumstances. Results The findings confirm important differences between birth cohorts and countries. French women report a higher risk of poor self-reported health and mental issues than English women. Full-time domestic duties were particularly deleterious for the health of the two younger cohorts, whereas a combination of employment and domestic duties across the life course had a positive association with later-life health. Discussion Further research is needed to explore the mechanisms linking work and care trajectories to poor health. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease (COVID)-secure workplace guidance, including the prompt self-isolation of those with COVID-19 symptoms, is fundamental to disease control in workplaces. Despite guidance, a large number of workplace outbreaks have been observed. This study aimed to identify the proportion of symptomatic staff members attending workplaces after symptom onset or testing, and associated factors. Methods This study of symptomatic COVID-19 cases associated with London workplaces used London Coronavirus Response Centre (LCRC) records from routine telephone calls with cases and employers, from 17th July to 10th September. For each case, symptoms, date of onset, date of testing and the last attendance at work were extracted. Univariable logistic regression was performed to investigate whether age, gender or occupation was associated with workplace attendance after the onset of symptoms. Results Out of 130 symptomatic COVID-19 cases, 42 (32.3%) attended the workplace after their reported date of symptom onset, including 16 (12.3%) with recorded COVID-19 symptoms. Five staff members attended after COVID-19 testing. Males were 66% less likely to attend the workplace after the onset of COVID-19 symptoms compared to females (odds ratio 0.34, P  = 0.05). Age and occupation were not predictive for workplace attendance after the onset of symptoms. Conclusion A minority of symptomatic cases attended the workplace after the onset of COVID-19 symptoms, with a smaller proportion attending after testing. Males appeared less likely to attend the workplace after the onset of COVID-19 symptoms. This study highlights the need for ongoing COVID-19 secure workplace practices and prompt self-isolation after COVID-19 symptom onset or testing. [ABSTRACT FROM AUTHOR]

Background Uptake of NHS Health Checks (NHSHCs) is sub-optimal. This study aimed to increase their uptake using behaviourally informed invitation letters. Method Patients registered with 6 general practices in Northamptonshire, England who were eligible for an NHSHC between 10 February 2014 and 31 January 2015 were randomized monthly, using a random number generator, to three trial arms: control (standard invitation), sunk costs (resources already allocated) and counterargument (against common barriers to attendance). The outcome measure was uptake of NHSHC by 12 weeks after 31 January. Results In total, 6331 patients were randomized. After exclusions, due to ineligibility for the NHSHC, data were analysed for N  = 6313 patients: N  = 2123 control; N  = 2085 counterargument; N  = 2105 sunk costs. Overall, 2364 (37.45%) patients attended an NHSHC. Both intervention letters increased uptake compared to control, by 5.46% using counterargument (adjusted odds ratio (AOR) 1.32, CI 1.162–1.51, p  < 0.001) and 4.33% using sunk costs (AOR 1.246, CI 1.10–1.42, p  < 0.001), with no significant difference between the two. Conclusion Behaviourally informed invitation letters, containing sunk costs or counterargument messages, can improve the uptake of NHSHCs. The trial was registered with the International Standard Randomised Controlled Trial Registration Number Scheme (ISRCTN57110614). [ABSTRACT FROM AUTHOR]

Background Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. Methods ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Results Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% CI: 0.71-0.95), secondary care referrals (OR = 0.68, 95% CI: 0.52-0.90), having a lack of motivation (OR = 0.81, 95% CI: 0.69-0.95) or a lack of childcare (OR = 0.69, 95% CI: 0.50-0.95) decreased the likelihood of dropout. Conclusion ERS dropout continues to be problematic. Smoking and having moderate-high comorbidities predicted dropout. Increasing age and patient-reported barriers of a lack of time or childcare decreased dropout risk. The reasons for dropout require further investigation. [ABSTRACT FROM AUTHOR]

Background The Health and Social Care Act 2012 (H&SCA) provided for sweeping changes to the health and healthcare system in England. The UK Faculty of Public Health (FPH) considered the risks of the proposed legislation and remains opposed to many of the Act's provisions. Methods Cross-sectional electronic survey of membership, on the severity and likelihood of risks identified in FPH's original risk assessment. Results Combined severity/likelihood scores rated all risks as severe or high. Respondents identified risks to infrastructure for local public health, healthcare planning and delivery and public health careers as most likely and as having the most severe consequences. Proposals for remediation included review, public health advocacy, co-ordinated working across organizational boundaries and further legislation. However, some respondents considered the current arrangements as irredeemable and advocated revoking the act and undertaking structural reorganization. Ten percent of eligible members responded. Respondents were more likely than the general membership to be in senior roles, with longer FPH membership. Conclusions Surveying public health professionals can provide insights into health and healthcare policy and its implementation. Their insights can assist in both further policy formulation and mitigation of risks for population health and health care. [ABSTRACT FROM AUTHOR]

Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO andX47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colderwinter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years. Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions. [ABSTRACT FROM AUTHOR]

Background To investigate the variation between coroners in the verdicts given to deaths thought by researchers to be probable suicides and analyse factors associated with the coroners’ verdict. Methods Data were collected from 12 English coroner districts on all deaths in 2005 given a suicide, open, accidental or narrative verdict where suicide was considered a possibility. The data were reviewed by three experienced suicide researchers. Regression models were used to investigate factors associated with the coroners’ verdict. Results The researchers classified 593 deaths as suicide, of which 385 (65.4%) received a suicide verdict from the coroner. There was marked variation between coroner districts in the verdicts they gave. The suicide method was associated strongly with the coroners’ verdict; deaths from poisoning and drowning were the least likely to be given suicide verdicts. The other factors strongly associated with a coroner's verdict of suicide were: whether a note was left, age over 60 years and being married or widowed compared with being single. Conclusion Coroners vary considerably in the verdicts they give to individuals who probably died by suicide. This may compromise the usefulness of suicide statistics for assessing area differences in rates for public health surveillance. [ABSTRACT FROM PUBLISHER]

Introduction High and equitable coverage of systematic cardiovascular disease (CVD) prevention programmes, such as the NHS Health Check programme in England, is essential if they are to effectively reduce the population CVD burden. Methods We conducted a cross-sectional study using data from 151 English primary care trusts (PCTs) on NHS Health Check coverage during 2011–12. We examined the associations between programme coverage and primary care and population factors, including patient demographics, primary care workforce and cardiovascular health need. Results Median coverage of NHS Health Checks was 8.2%, with wide PCT-level variation (range = 0–29.8%). Coverage was significantly higher in PCTs in the most deprived areas compared with the least deprived (P = 0.035), adjusting for covariates. Significant negative associations between coverage and a higher proportion of PCT population aged 40–74 years—the eligible Health Check age group, a larger total population size and higher practice staffing levels were found in the unadjusted analyses. Conclusions NHS Health Check coverage during 2011–12 was lower than the government projection of 18% coverage. Coverage must be increased through concerted multi-disciplinary strategies, for the programme to improve cardiovascular health in England. Considerable variation in participation between PCTs warrants attention, with enhanced support for poor performers. [ABSTRACT FROM AUTHOR]

Background Suicide by carbon monoxide poisoning from burning barbecue charcoal has become a common method of suicide in several Asian countries over the last 15 years. The characteristics of people using this method in Western countries have received little attention. Method We reviewed the inquest reports of 12 English Coroners (11% of all Coroners) to identify charcoal-burning suicides. We compared socio-demographic and clinical characteristics of suicide by charcoal burning occurring between 2005 and 2007 with suicides using other methods in 2005. Results Eleven charcoal-burning suicides were identified; people using this method were younger (mean age 33.4 versus 44.8 years, P = 0.02), and more likely to be unemployed (70.0 versus 30.1%, P = 0.01) and unmarried (100 versus 70%, P = 0.04) than those using other methods. Charcoal-burning suicides had higher levels of contact with psychiatric services (80.0 versus 59.1%) and previous self-harm (63.6 versus 53.0%) compared with suicides using other methods, but these differences did not reach conventional levels of statistical significance. Over one-third of people dying by charcoal burning obtained information on this method from the Internet. Conclusions Working with media, including Internet Service Providers, and close monitoring of changes in the incidence of suicide using this method might help prevent an epidemic of charcoal-burning suicides such as that seen in some Asian countries. [ABSTRACT FROM PUBLISHER]

Background Most cases of Type 2 diabetes are attributable to excess weight and physical inactivity. We investigated trends in mortality based on doctors' certification of diabetes and obesity. Methods Analysis of a national data set of all certified causes of death, i.e. underlying cause and contributing causes (‘mentions’), in England 1995–2010. Results Diabetes exhibited divergent trends for mortality based on underlying cause and mentions. Underlying cause rates were 107.2 per million population [95% confidence interval (CI): 105.7–108.6] in 1995, but only 68.9/106 (CI: 67.9–69.9) in 2010. Mortality rates for mentions of diabetes were 403.1/106 (CI: 400.4–405.8) in 1995, increasing to 478.4/106 (CI: 475.7–481.0) in 2010. Underlying cause mortality for obesity was 3.7/106 (CI: 3.2–4.1) in 1995 and 7.5 (CI: 7.0–8.0) in 2010. The corresponding rates for mentions of obesity were 13.2/106 (CI: 12.6–13.9) and 34.5/106 (CI: 33.6–35.4), respectively. 24.0% of death certificates with a mention of obesity also had diabetes recorded on the same certificate. Conclusions Multiple-cause mortality statistics provide a more accurate picture than underlying cause of the total mortality burden attributed on death certificates to diabetes and obesity. Rates for both increased substantially: analysis by underlying cause alone would have missed this for diabetes. [ABSTRACT FROM PUBLISHER]

Background In England both emergency (unplanned) and non-emergency (elective) hospital admissions have been increasing. Some elective admissions are potentially avoidable. Aim: to identify the characteristics of general practices and patients associated with elective admissions. Methods A cross-sectional study, in Leicestershire, England, was conducted using admission data (2006–07 and 2007–08). Practice characteristics (list size, distance from principal hospital, quality and outcomes framework score and general practitioner (GP) patient access survey data) and patient characteristics (age, ethnicity and deprivation and gender) were used as predictors of elective hospital admissions in a negative binomial regression model. Results Practices with a higher proportion of patients aged 65 years or greater and of white ethnicity had higher rates of elective hospital admissions. Practices with more male patients and with more patients reporting being able to consult a particular GP had fewer elective hospital admissions. For 2007–08 practices with a larger list size were associated with higher elective hospital admissions. Quality and outcomes framework performance did not predict admission numbers. Conclusions As for unplanned admissions, elective admissions increase as being able to consult a particular GP declines. Interventions to improve continuity should be investigated. Practices face major problems in managing the increased need for planned care as the population ages. [ABSTRACT FROM PUBLISHER]

Background Differences in the use of hip and knee replacement by sex, age, ethnicity or socioeconomic status may lead to differences in disease severity between those who have surgery. Methods Analyses used data collected from 117 736 patients in 2009–10 via the Patient Reported Outcome Measures (PROMs) programme in England. Adjusted differences were estimated in the Oxford Hip Score (OHS) or the Oxford Knee Score (OKS), both expressed on a scale from 0 to 48, and the proportion with longstanding problems (>5 years), expressed as odds ratios (ORs). Results Women had more severe pain and disability than men on average (difference OHS 2.3 and OKS 3.3), but less often longstanding problems. Compared with white patients, average severity was higher in South Asian patients (difference OHS 2.7 and OKS 3.0) and in black patients (difference OHS 0.9 and OKS 1.6), who also more often had longstanding problems (OR 1.40 for hip and 1.54 for knee). Patients from deprived areas had more severe disease (difference OHS 3.6 and OKS 3.3 between least and most deprived quintile). Conclusions There is evidence that non-white and deprived patients tend to have hip and knee replacement surgery at a later stage in the course of their disease. [ABSTRACT FROM PUBLISHER]

Background Teenage pregnancy rates in the UK are the highest in Western Europe. Causes of teenage pregnancies are multifaceted with complex interplay of social, lifestyle and wider determinants influencing risk. Improving access to sexual health services through community services is an important factor in attempting to tackle this issue, but few studies have examined factors that influence this. Methods Geospatial analysis was conducted on community sexual health service users and teenage conceptions from local sexual health services were recorded. Univariate and multinomial regression was performed to test associations between service type and socio-economic status. Results No significant differences in accessibility of services between teenage girls who have conceived and those seeking sexual health services were found. Females aged 17 and under were more likely to use a young people's sexual health service than mainstream services (P < 0.001). However, a young person living in the most deprived quintiles was more likely to use a mainstream service if it was closer to their home address (adjusted odds ratios: 2.154, 95% confidence intervals: 1.533–3.027). Conclusions Service type and socio-economic status impact upon the choices young people make when accessing community sexual health services. The study supports policy for locating young person services within the most deprived areas of a community. [ABSTRACT FROM PUBLISHER]

Background The UK is embarking on a national cardiovascular risk assessment programme called NHS Health Checks; in order to be effective, high and equitable uptake is paramount. Methods A cross-sectional study, using data extracted from electronic medical records of persons aged 35–74 years estimated to be at a high risk of developing cardiovascular disease, to examine the uptake of the Health Checks using logistic regression and statin prescribing. Results A total of 44.8% of high risk patients invited for a Health Check attended. Uptake was lower among younger men but higher among patients from south Asian (AOR = 1.71 [1.29–2.27] compared with white) or mixed ethnic backgrounds (AOR = 2.42 [1.50–3.89]), and patients registered with smaller practices (AOR = 2.53 [1.09–5.84] <3000 patients compared with 3000–5999). The percentage of patients confirmed to be at high risk of CVD prescribed a statin increased from 24.7 to 44.8%. Conclusions Uptake of cardiovascular risk assessment and prescribing of statins in high risk patients was considerably lower than projected in the first year of NHS Health Checks programme. Targeting efforts to increase uptake and adherence to interventions in high risk populations and reinvesting resources into population wide strategies to reduce obesity, smoking and salt intake may prove more cost-effective in reducing the burden of cardiovascular disease in the UK. [ABSTRACT FROM PUBLISHER]

Background Since 2000 English cancer policy has directed extra funding towards improving cancer outcomes and quality of care. Few evaluations have related programme budget data on cancer spending to population differences, disease burden, outcome or service activity for cancer. We used existing routine data to explore these associations for 39 primary care trusts (PCTs) in South East England in 2005–2007. Methods We plotted the cancer spending reported by PCTs in pounds per 100 000 population against measures of population characteristics, disease burden and treatment and hospital activity. We explored associations with PCT size, deprivation, age-standardized cancer incidence and mortality rates, proportions treated with surgery, radiotherapy and chemotherapy and per capita bed days. Results Lower per capita spending on cancer was associated with smaller PCT populations and a higher proportion of deprived areas within them. Higher spending was associated with higher proportions of radiotherapy treatment and higher per capita hospital bed days for cancer. Conclusion Cancer spending reported by South East England PCTs does not appear to be related to disease burden, but may relate to treatment and service activity. Models are required to relate possible effects of different expenditures and interventions to improve population outcomes for cancer. [ABSTRACT FROM PUBLISHER]

Background Fractures of the proximal femur are an important public health concern. The incidence of hip fractures is an index of osteoporosis burden. There have been no recent studies examining national trends in hip fractures in England. Methods We used national data for 1998–2009 from the English Hospital Episode Statistics database. Patients with an admission for hip fracture (574 482 admissions) were identified. Results Between 1998 and 2009, there was little change in age-standardized hip fracture rates (102.0–101.8 fractures per 100 000 person-years), but age-standardized in-hospital mortality decreased by 16.5% (95% CI (confidence interval): −18.5 to −8.4%) (126.9–106.0 deaths per 1000 hip fracture admissions). The majority of hip fractures and deaths occurred in females and older people. A socioeconomic gradient of 25.9% difference (95% CI: 15.7–36.1%) existed for mortality in 2008 (93.5–117.7 per 1000). Conclusions Hip fracture rates have not decreased in England since 1998, although inpatient mortality rates have declined. There is a socioeconomic gradient for in-hospital hip fracture deaths. [ABSTRACT FROM PUBLISHER]

Background Childhood tuberculosis (TB) represents a sentinel event of recent transmission and is an indication of the effectiveness of prevention and control interventions. We analysed the trends in the epidemiology of TB in children in London aged 0–14 years between 1999 and 2006. Methods Data were extracted from the Enhanced TB Surveillance System. Results Between 1999 and 2006, there were 1370 cases of TB in children. Incidence was higher in older children and in girls. The incidence rates in London Boroughs varied from 0.4/100 000 to 32.7/100 000. Between 1999 and 2006, Black-Africans comprised 49.2% of all TB cases in children, children from the Indian Subcontinent 21.8% and Whites 8.5%. The proportion of cases born in the UK averaged 52.4% during this period. Of non-UK-born children 79.3% were diagnosed with TB within 5 years of entry. Conclusions Ethnicity, country of birth and age are important risk factors for development of. With an overall TB incidence in London exceeding 40/100 000, universal BCG immunization of all neonates should be considered across all London boroughs. [ABSTRACT FROM PUBLISHER]

Background Benign breast disease (BBD) increases the risk of breast cancer, but details of the relationship would benefit from further study in the UK. Methods Analysis of linked statistical abstracts of hospital data, including a cohort of 20 976 women with BBD in an Oxford data set and 89 268 such women in an English national data set. Results Rate ratios (RRs) for breast cancer, comparing BBD and comparison cohorts in these two data sets, were 2.3 (95% CI: 2.2–2.5) and 3.2 (3.0–3.3), respectively. RRs rose with increasing age at BBD diagnosis and remained elevated for at least 20 years after diagnosis. RRs were particularly high for a relatively small number of cancers occurring in the first few months after BBD diagnosis. Conclusions Our findings accord well with those in other large studies, mostly done in the USA, in showing a sustained long-term cancer risk after BBD. They also demonstrate that known long-term risks of disease can be reliably identified from linked routine administrative hospital statistics. Most other studies omit cancers in the first few months after BBD. Such cases—presumably either misdiagnosed or miscoded—merit further study to determine whether in fact they include diagnoses of cancer that were initially missed. [ABSTRACT FROM PUBLISHER]

Background To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006. Methods Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n = 1171), 1993 (n = 2368) 1998 (n = 1964) and in 2006 (n = 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (C+W+B+). Results Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4% (P < 0.001). Prevalence of C+W+B+ increased from 7.8 to 8.0% by 1998, then decreased to 6.7% in 2006 (P = 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7% (P = 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7% (P = 0.001) and maternal asthma from 11.2 to 13.4% (P = 0.09). Conclusions An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period. [ABSTRACT FROM PUBLISHER]

Background Uptake of colorectal cancer (CRC) screening in UK is less than 60%. Geodemographic typologies are useful in describing patterns of individual preventive health behaviour but little is known of their value in assessing uptake of CRC screening, or how this compares to traditional measures of area deprivation. Methods We used data on CRC screening uptake in the South Central, South-East Coast and South-West England National Health Service regions in multilevel logistic regression to describe the effects of individual composition and contextual factors (area deprivation and geodemographic segments) on non-response to screening invitation. The relative impact of geodemographic segmentation and the index of multiple deprivation (IMD) 2007 was compared. The potential population impact of a targeted increase in uptake in specific geodemographic segments was examined. Results About 88 891 eligible adults were invited to be screened from 2006 to 2008. Uptake rate was 57.3% (CI: 57.0–57.7) and was lower amongst younger persons, men, residents of more deprived areas and people in specific geodemographic segments. Age and gender were significant determinants of uptake and contextual factors explained an additional 3% of the variation. Geodemographic segmentation reduced this residual contextual variation in uptake more than the IMD 2007 (72% vs. 53% reduction). The three geodemographic types that best predicted non-response were characterized by both ethnic mix and a higher than average proportion of single pensioner households renting council properties. Achieving average uptake in the 2.3% of the study population in these geodemographic segments would only increase the total population uptake rate by 0.5% (57.3–57.8%). Conclusion Variation in the CRC screening uptake in Southern England is principally explained by characteristics of individuals but contextual factors also have a small but significant effect. This effect is captured in greater detail by geodemographic segmentation than by IMD 2007. This information could be used to inform the design of interventions aiming to improve uptake. [ABSTRACT FROM PUBLISHER]

: Background Differences in mortality by country of birth in England and Wales in people under 70 years of age have been demonstrated previously. Changes in age distribution of migrants and in migration patterns have occurred subsequently. : Methods All-cause and circulatory disease mortality for people aged 20 years and over in England and Wales by country of birth were examined using population data from the 2001 Census and mortality data for 2001–2003. Indirect standardization was used to estimate sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) in comparison to mortality for England and Wales as a whole. : Results SMRs for all-cause mortality were statistically significantly higher than the national average for people born in Ireland, Scotland, East Africa and West Africa and lower for people born in China and Hong Kong. SMRs for circulatory disease were highest among people born in Bangladesh and lowest among people born in China and Hong Kong. Patterns of ischaemic heart disease and cerebrovascular disease mortality differed by country of birth. : Conclusions Mortality, particularly due to ischaemic heart disease and stroke, differs markedly by country of birth in all age groups including the =70-year-old group. [ABSTRACT FROM AUTHOR]