Search

Background: There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. Methods: As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. Results: While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. Conclusions: In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value. [ABSTRACT FROM AUTHOR]

Objectives To investigate parental smoking behaviours between England and Scotland after the smoke-free legislation in Scotland came into effect in 2006 and examine inequalities in maternal smoking behaviours between countries. Methods 5954 white mothers and 3757 fathers resident in England and 1522 white mothers and 904 fathers resident in Scotland who participated in the Millennium Cohort Study (a prospective nationally representative cohort study) when the cohort child was age 9 months (before legislation) and 5 years (after legislation in Scotland but not in England). The main outcome measures were smoking at 9 months and 5 years, quitting smoking by 5 years, starting smoking by 5 years. Results In England and Scotland approximately 30% of parents reported smoking at 9 months with only a slight decrease in smoking at 5 years. There were no differences between countries in parental smoking after the smoke-free legislation in Scotland came into effect, taking into account prior smoking levels. Light smokers (1-9 cigarettes/day) from Scotland were less likely to quit by 5 years than those from England, but there were no differences between countries among heavy smokers (10+ cigarettes/day). Non-smoking mothers from Scotland (6.2%) were less likely to start smoking by 5 years than mothers from England (7.3%). Mothers from more disadvantaged circumstances in both countries were more likely to report that they smoked or started smoking. In England quitting was also socially patterned, but in Scotland, after the legislation was introduced, the gradients in quitting smoking were flatter across social groups. Conclusions Smoking behaviours among parents with young children remained relatively stable, highlighting the need for additional tobacco control efforts to support smoking cessation. However, the smoke-free legislation does not appear to widen health inequalities and may even help reduce them by encouraging quitting across socioeconomic groups. [ABSTRACT FROM AUTHOR]

This section offers medical news briefs including the passing of a motion by general practitioners (GPs) in Scotland calling for restrictions on e-cigarettes, the rehiring of nearly 4,000 National Health Service (NHS) staff who were previously laid off in England, and the more than 50 percent decrease in the prevalence of tuberculosis in China between 1990 and 2010.

Presents information on the white papers of England and Scotland and their benefits and problems. Detailed information on these papers; Details on the benefits; Problems with these papers.

Background The Measurement and Monitoring of Safety Framework provides a conceptual model to guide organisations in assessing safety. The Health Foundation funded a large-scale programme to assess the value and impact of applying the Framework in regional and frontline care settings. We explored the experiences and reflections of key participants in the programme. Methods The study was conducted in the nine healthcare organisations in England and Scotland testing the Framework (three regional improvement bodies, six frontline settings). Post hoc interviews with clinical and managerial staff were analysed using template analysis. Findings Participants reported that the Framework promoted a substantial shift in their thinking about how safety is actively managed in their environment. It provided a common language, facilitated a more inquisitive approach and encouraged a more holistic view of the components of safety. These changes in conceptual understanding, however, did not always translate into broader changes in practice, with many sites only addressing some aspects of the Framework. One of the three regions did embrace the Framework in its entirety and achieved wider impact with a range of interventions. This region had committed leaders who took time to fully understand the concepts, who maintained a flexible approach to exploring the utility of the Framework and who worked with frontline staff to translate the concepts for local settings. Conclusions The Measuring and Monitoring of Safety Framework has the potential to support a broader and richer approach to organisational safety. Such a conceptually based initiative requires both committed leaders who themselves understand the concepts and more time to establish understanding and aims than might be needed in a standard improvement programme. [ABSTRACT FROM AUTHOR]

Background Up until the mid-late 2000s, the national suicide rate in Scotland was the highest among all the UK countries, but the reasons for this phenomenon are poorly understood. Methods In a multilevel study of suicide risk in Scotland and England during 2001-2006, the authors examined a range of social, cultural and health-related factors at small area level: postcode sector and Health Board in Scotland and ward and Primary Care Organisation in England. Results Scotland's national suicide rate was 79% higher than in England (rate ratio 1.79, 95% CI 1.62 to 1.98), with younger male and female Scots aged 15-44 years having double the risk compared with their English peers. Overall, 57% of the excess suicide risk in Scotland was explained by a range of area-level measures, including prescriptions for psychotropic drugs, alcohol and drug use, socioeconomic deprivation, social fragmentation, and other health-related indices. The use of psychotropic drugs, acting as a proxy measure for mental ill health, was the variable most strongly associated with the between-country differences in suicide risk. Alcohol misuse also made an important contribution to the differentials. Overall, the contribution of socioeconomic deprivation and social fragmentation was relatively small. Conclusions Any attempt to reverse the divergent trend in suicide between Scotland and England will require initiatives to prevent and treat mental ill health and to tackle alcohol and drug misuse. Differences in prescribing rates, however, may also be explained by differences in illness behaviour or the availability of psychosocial interventions, and addressing these may also reduce Scotland's excess risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: The minimum age for the legal purchase of tobacco increased from 16 to 18 years in England, Scotland and Wales on 1 October 2007. The authors examined the impact of this legislation on disparities in smoking behaviour and access to cigarettes among youth in England. METHODS: A multivariate logistic regression analysis was carried out adjusting for secular trends in regular smoking using data from the Smoking, Drinking and Drug Use Survey, a national survey of 11–15 year olds. The primary outcome measure was regular smoking and the predictor variables were the law increasing the minimum age for purchase and eligibility for free school meals (FSM). RESULTS: Increasing the minimum age for purchase was associated with a significant reduction in regular smoking among youth (adjusted OR 0.67; 95% CI 0.55 to 0.81, p=0.0005). This effect was not significantly different in pupils eligible for FSM compared with those that were not (adjusted OR 1.29; 95% CI 0.95 to 1.76, p=0.10 for interaction term). The percentage of pupils who stated that they found it difficult to buy cigarettes from a shop did not increase in those eligible for FSM (25.2% to 33.3%; p=0.21) but did increase significantly in others (21.2% to 36.9%; p<0.01) between 2006 and 2008. No differences in ease of purchase were found between pupils eligible for FSM and those not before or after the legislation (2006: p=0.34, 2008: p=0.55). CONCLUSIONS: Increasing the age for the legal purchase of tobacco was associated with reduced regular smoking among youth in England and appeared to have a similar impact in different socio-economic groups. [ABSTRACT FROM AUTHOR]

Offers medical news briefs for four research papers that were published in JAMA or Lancet during 2005. Researchers found that erectile dysfunction could be a signal for cardiovascular disease in American men. Proton pump inhibitors and H2 receptor antagonists are being linked to the increased incidence of Clostridium difficile infections in the United Kingdom. A study on dementia found that it is a global problem that will aflict 81 million people by 2040. A study in Scotland found that sudden infant death syndrome is associated with complications in other pregnancies.

Objectives: To quantify measurement error in the estimation of family diet intakes using 7-day household food inventories and to investigate the effect of measurement-error adjustment on diet-disease associations. Design and setting: Historical cohort study in 16 districts in England and Scotland, between 1937 and 1939. Subjects: 4999 children from 1352 families in the Carnegie Survey of Diet and Health. 86.6% of these children were traced as adults and form the Boyd Orr cohort. The reproducibility analysis was based on 195 families with two assessments of family diet recorded 3–15 months apart. Methods: Intraclass correlation coefficients (ICCs) were calculated for a variety of nutrients and food groups. Diet-cancer associations reported previously in the Boyd Orr cohort were reassessed using two methods: (a) the ICC and (b) the regression calibration. Main results: The ICCs for the dietary intakes ranged from 0.44 (β carotene) to 0.85 (milk and milk products). The crude fully adjusted hazard ratio (HR) for cancer mortality per 1 MJ/day increase in energy intake was 1.15 (95% CI 1.06 to 1.24). After adjustment using the ICC for energy (0.80) the HR (95% CI) increased to 1.19 (1.08 to 1.31), and the estimate from regression calibration was 1.14 (0.98 to 1.32). The crude fully adjusted odds ratio (OR) for cancer incidence per 40 g/day increase in fruit intake was 0.84 (95% CI 0.73 to 0.97). After adjustment using the fruit ICC (0.78) it became 0.81 (0.67 to 0.96) and the OR derived from regression calibration was 0.81 (0.59 to 1.10). Conclusions: The diet-disease relationships for the dietary intakes with low measurement error were robust to adjustment for measurement error. [ABSTRACT FROM AUTHOR]

Objective: To assess the association of having been breast fed with social class mobility between childhood and adulthood. Design: Historical cohort study with a 60-year follow-up from childhood into adulthood. Setting: 16 urban and rural centres in England and Scotland. Participants: 3182 original participants in the Boyd Orr Survey of Diet and Health in Pre-War Britain (1937–39) were sent follow-up questionnaires between 1997 and 1998. Analyses are based on 1414 (44%) responders with data on breast feeding measured in childhood and occupational social class in both childhood and adulthood. Main outcome: Odds of moving from a lower to a higher social class between childhood and adulthood in those who were ever breast fed versus those who were bottle fed. Results: The prevalence of breast feeding varied by survey district (range 45-86%) but not with household income (p=0.7), expenditure on food (p=0.3), number of siblings (p=0.7), birth order (p=0.5) or social class (p=0.4) in childhood. Participants who had been breast fed were 41% (95% CI 10% to 82%) more likely to move up a social class in adulthood (p=0.007) than bottle-fed infants. Longer breastfeeding duration was associated with greater odds of upward social mobility in fully adjusted models (p for trend=0.003). Additionally controlling for survey district, household income and food expenditure in childhood, childhood height, birth order or number of siblings did not attenuate these associations. In an analysis comparing social mobility among children within families with discordant breastfeeding histories, the association was somewhat attenuated (OR 1.16; 95% CI 0.74 to 1.8). Conclusions: Breast feeding was associated with upward social mobility. Confounding by other measured childhood predictors of social class in adulthood did not explain this effect, but we cannot exclude the possibility of residual or unmeasured confounding. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the social characteristics associated with the height of primary schoolchildren aged from 5 to 11. Data were analysed for 8491 representative sample children measured in England and Scotland in 1987 and 1988 and 3203 inner city children measured in England in 1987. Height was negatively associated with social class but the association was not significant after allowing for biological variables. A negative gradient of height with size of sibship was evident in white children but was less so in Afro-Caribbean and Asian children. The individual associations of 11 different environmental characteristics were examined after allowing for biological factors and size of sibship. Consistent associations with height included a negative gradient of height with increasing latitude and an association of taller stature with increasing maternal age. A social class gradient in height is accounted for by associations with biological factors, particularly the parental heights; environmental attributes are weakly associated with height after allowing for biological factors. [ABSTRACT FROM AUTHOR]

The relation between ventilatory function and the reported frequency of consumption of fresh fruit and fruit juice was studied among 1502 lifelong non-smokers and 1357 current smokers aged 18-69 with no history of chronic respiratory disease. Forced expiratory volume in one second (FEV1) was assessed by turbine spirometry. As winter fruit consumption was more widely dispersed than summer consumption and few subjects ate fruit more frequently in the winter, winter fruit consumption was taken as an indicator of habitual (year round) consumption. After adjustment for sex, age, height, cigarette consumption, region of residence, and household socioeconomic group, FEV1 was associated with winter fruit consumption. The mean adjusted FEV1 among those who never drank fresh fruit juice and ate fresh fruit less than once a week during the winter was 78 ml lower (95% confidence interval 24-132 ml) than the mean for the other subjects. A similar difference was found in all age-sex groups and among both current smokers and lifelong non-smokers. Antioxidant and other actions of vitamin C may protect against pulmonary emphysema, or reduce bronchoconstrictor responses to environmental pollutants. [ABSTRACT FROM PUBLISHER]

Study objectives: To (1) compare prevalence of socioeconomic, behavioural, and physiological ischaemic heart disease (IHD) risk factors in Scotland with a comparable nation (England) and (2) find out if their distribution explains Scotland's comparatively higher IHD rate (1.62 (1.30, 2.02)). Design, setting, and participants: Cross sectional, individual level observational study with data on socioeconomic, behavioural, and physiological characteristics, 664 respondents from Scotland and England, (2362 and 3702 respectively), aged 45-74 and with data on all required items. Main results: There were significant and meaningful differences between the Scottish and English in the prevalence of several IHD risk factors. However, a substantially and significantly higher risk of IHD persisted among the Scottish respondents (1.50 (1.17, 1.91)) despite control for a wide range of risk factors. Conclusions: Interpretation must be cautious because these are cross sectional data, however higher levels of conventional IHD risk factors contribute to but do not explain the comparatively high rates of IHD in Scotland. Alternative explanations for, and policy interventions to tackle, Scottish rates of IHD must be considered. [ABSTRACT FROM AUTHOR]

The author focuses on the issue of increase in mortality rate in England and Wales that occurred in the first half of 2013. He mentions that the National Health Service (NHS) reform cannot be blamed for increasing rate of death. He further mentions that NHS budgets are flat due to which the reforms in England and Wales were an additional burden that caused declines in care.