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Background: Antimicrobial resistance is a global public health problem with some socially patterned drivers. The objective of the study was to investigate associations between use of and trust in the Internet as a source of health-related information and the public’s knowledge, attitudes, and behaviours regarding antibiotics. Methods: Two representative cross-sectional surveys (the 2015 Wellcome Monitor (n = 1524) and UK segment (n = 1330) of the 2016 Eurobarometer 85.1) covering knowledge about antibiotics and antibiotic consumption were analysed. Knowledge, attitude, and behaviour variables were analysed using regression in relation to demographic characteristics and use and trust in the Internet as a source of information. Results: The key findings of the analysis are that both use of the Internet as a source of medical research information (variable from the Wellcome Monitor) and trust in the Internet as a source of information about antibiotics (variable from the Eurobarometer) were independently and positively associated with knowledge, attitude, and behaviour regarding antibiotics. Additionally, knowledge about antibiotics was positively associated with behaviour with antibiotics (Wellcome Monitor) and attitude towards finishing antibiotic prescriptions (Eurobarometer). Higher levels of education were associated with better knowledge about antibiotics in both datasets. Older age was positively associated with behaviour and attitude regarding antibiotic consumption. Conclusions: The Internet is a resource for disseminating quality health information that has the potential to improve stewardship of antibiotics in the community. This study suggests that members of the UK public that use the Internet as a source of health-related information are more likely to be better informed about, and be more responsible with, antibiotics. This mode of information dissemination should be capitalised on to improve antimicrobial stewardship, and further research should examine what the most effective online information sources are in the UK and to what extent their association with behaviour is causal. [ABSTRACT FROM AUTHOR]

Background: Aiming to contribute to prevention of cardiovascular disease (CVD), the National Health Service (NHS) Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification-at 5-year intervals-of all adults between the ages of 40 and 74 years, excluding any with preexisting vascular conditions (including CVD, diabetes mellitus, and hypertension, among others), and offers treatment to those at high risk. However, the cost-effectiveness and equity of population CVD screening is contested. This study aimed to determine whether the NHS Health Check programme is cost-effective and equitable in a city with high levels of deprivation and CVD.Methods and Findings: IMPACTNCD is a dynamic stochastic microsimulation policy model, calibrated to Liverpool demographics, risk factor exposure, and CVD epidemiology. Using local and national data, as well as drawing on health and social care disease costs and health-state utilities, we modelled 5 scenarios from 2017 to 2040: Scenario (A): continuing current implementation of NHS Health Check;Scenario (B): implementation 'targeted' toward areas in the most deprived quintile with increased coverage and uptake;Scenario (C): 'optimal' implementation assuming optimal coverage, uptake, treatment, and lifestyle change;Scenario (D): scenario A combined with structural population-wide interventions targeting unhealthy diet and smoking;Scenario (E): scenario B combined with the structural interventions as above. We compared all scenarios with a counterfactual of no-NHS Health Check. Compared with no-NHS Health Check, the model estimated cumulative incremental cost-effectiveness ratio (ICER) (discounted £/quality-adjusted life year [QALY]) to be 11,000 (95% uncertainty interval [UI] -270,000 to 320,000) for scenario A, 1,500 (-91,000 to 100,000) for scenario B, -2,400 (-6,500 to 5,700) for scenario C, -5,100 (-7,400 to -3,200) for scenario D, and -5,000 (-7,400 to -3,100) for scenario E. Overall, scenario A is unlikely to become cost-effective or equitable, and scenario B is likely to become cost-effective by 2040 and equitable by 2039. Scenario C is likely to become cost-effective by 2030 and cost-saving by 2040. Scenarios D and E are likely to be cost-saving by 2021 and 2023, respectively, and equitable by 2025. The main limitation of the analysis is that we explicitly modelled CVD and diabetes mellitus only.Conclusions: According to our analysis of the situation in Liverpool, current NHS Health Check implementation appears neither equitable nor cost-effective. Optimal implementation is likely to be cost-saving but not equitable, while targeted implementation is likely to be both. Adding structural policies targeting cardiovascular risk factors could substantially improve equity and generate cost savings. [ABSTRACT FROM AUTHOR]

Background: Health care systems in OECD countries are increasingly facing economic challenges and funding pressures. These normally demand interventions (political, financial and organisational) aimed at improving the efficiency of the health system as a whole and its single components. In 2009, the English NHS Chief Executive, Sir David Nicholson, warned that a potential funding gap of £20 billion should be met by extensive efficiency savings by March 2015. Our study investigates possible drivers of differential Trust performance (productivity) for the financial years 2010/11-2012/13. Methods: Following accounting practice, we define Productivity as the ratio of Outputs over Inputs. We analyse variation in both Total Factor and Labour Productivity using ordinary least squares regressions. We explicitly included in our analysis factors of differential performance highlighted in the Nicholson challenge as the sources were the efficiency savings should come from. Explanatory variables include efficiency in resource use measures, Trust and patient characteristics, and quality of care. Results: We find that larger Trusts and Foundation Trusts are associated with lower productivity, as are those treating a greater proportion of both older and/or younger patients. Surprisingly treating more patients in their last year of life is associated with higher Labour Productivity. [ABSTRACT FROM AUTHOR]