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Byline: Zoe Philips, PhD (Centre for Health Economics, University of York, UK, zoe.philips@astrazeneca.com); Karl Claxton, DPhil (Centre for Health Economics, University of York, UK); Stephen Palmer, MSc (Centre for Health [...]

Byline: Laura Bojke, MSc (Centre for Health Economics, kpc1@york.ac.uk, University of York, York, United Kingdom); Karl Claxton, PhD (Centre for Health Economics, University of York, York, United Kingdom, Department of [...]

This paper investigates multilevel associations between the common mental disorders of anxiety, depression and economic inactivity measured at the level of the individual and the UK 2001 census ward. The data set comes from the Caerphilly Health & Social Needs study, in which a representative survey of adults aged 18-74 years was carried out to collect a wide range of information which included mental health status (using the Mental Health Inventory (MHI-5) scale of the Short Form-36 health status questionnaire), and socio-economic status (including employment status, social class, household income, housing tenure and property value). Ward level economic inactivity was measured using non-means tested benefits data from the Department of Work and Pensions (DWP) on long-term Incapacity Benefit and Severe Disablement Allowance. Estimates from multilevel linear regression models of 10,653 individuals nested within 36 census wards showed that individual mental health status was significantly associated with ward-level economic inactivity, after adjusting for individual-level variables, with a moderate effect size of -0.668 (standard error = 0.258). There was a significant cross-level interaction between ward-level and individual economic inactivity from permanent sickness or disability, such that the effect of permanent sickness or disability on mental health was significantly greater for people living in wards with high levels of economic inactivity. This supports the hypothesis that living in a deprived neighbourhood has the most negative health effects on poorer individuals and is further evidence for a substantive effect of the place where you live on mental health. Keywords: UK; Mental health; Unemployment; Permanent sickness and disability; Multilevel modelling; Place; Socio-economic status

I. Introduction II. The Chromosomal Basis of Mammalian Sex Determination III. Morphology and Cell Biology of the Developing Gonad A. The bipotential gonad B. Development and differentiation of the ductal [...]

There has been much speculation about a possible association between the social and built environment and health, but the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation, social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the individual level (households and postcodes) in order to assess if these constructs reflect some contextual effect; and (3) to study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these derived factors. A cross-sectional household survey was undertaken during May-August 2001 in a district of South Wales with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and 10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus suggesting that some of our compositional measures capture contextual characteristics of the built and social environment. After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors to show statistically significant associations with GHQ-12 scores. However, these factors also showed little variation at postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the contextual nature of social capital. Keywords: Social capital; Mental health; Contextual effects; Wales

Physical education (PE) can make meaningful contributions to public health by directly providing moderate to vigorous physical activity (PA) opportunities for school-aged youth. Quality PE aims to contribute indirectly to PA beyond the school day. Unfortunately, insufficient evidence exists regarding the impact of PE on lifelong PA. This has led PE to a crossroads. Moving straight through the crossroads adds comprehensive school physical activity program responsibilities to the PE teacher’s load. Turning left results in PE teachers being replaced by PA leaders. The right turn reaffirms that the aim of PE is to teach youth the skills, knowledge, and dispositions to become physically literate and active for life. The right turn is the most difficult because it requires systemically changing school PE that has remained stagnant for decades. Recommendations are presented that include embracing the comprehensive school physical activity program model, conducting research clearly defining the role of PE and directing the contributions of PE to broader public health aims. [ABSTRACT FROM PUBLISHER]

Rational Coaching is based on the Rational Emotive Behavioural Approach developed by Albert Ellis. It is suitable for personal/life, performance, executive and health coaching. This paper covers the basic theory and practice of Rational Coaching and includes the ABCDEF coaching framework for assessment and intervention. [ABSTRACT FROM AUTHOR]

Background: Background: The glycoprotein IIb/IIIa antagonists (GPAs) represent a new class of drugs to prevent platelet aggregation in the acute treatment of non-ST-elevation acute coronary syndromes (NSTE-ACS). Systematic reviews have identified serious limitations in published cost-effectiveness analyses, including a lack of UK-specific studies and an absence of studies comparing different protocols for the use of GPAs. Methods: A model was developed to assess the cost effectiveness of a variety of protocols employing GPAs for patients presenting with NSTE-ACS in the UK. The perspective of the UK National Health Service was adopted, with outcomes in terms of quality-adjusted life-years (QALYs). Four treatment strategies were evaluated: GPAs as part of initial medical management (Strategy 1); GPAs in patients with planned percutaneous coronary interventions (PCIs; Strategy 2); GPAs as an adjunct to the PCI procedure (Strategy 3); and no GPAs (Strategy 4). Baseline event rates and costs were taken from a UK observational study of ACS patients and relative risk reductions from GPAs were taken from a meta analysis of trials. Long-term costs and QALYs were estimated using data from a UK longitudinal study. Results: The most cost-effective use of GPAs is likely to be Strategy 1, with an incremental cost per QALY gained of between £4605 to £10,343. Focusing this use of GPAs only on the subgroup of patients at high risk appears to represent the most cost-effective use of NHS resources. Conclusions: Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups. [Copyright &y& Elsevier]

Editorial. Discusses modern health problems highlighting the need for clean drinking water and sewage. Efforts of Holland to apply for the application of the permissive powers of the 1848 Public Health Act; Contention that for proper health care to prevail more is needed than proper sanitation.