Search results
Found 19893 matches for
We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Years of life lost to COVID-19 in 81 countries
Understanding the mortality impact of COVID-19 requires not only counting the dead, but analyzing how premature the deaths are. We calculate years of life lost (YLL) across 81 countries due to COVID-19 attributable deaths, and also conduct an analysis based on estimated excess deaths. We find that over 20.5 million years of life have been lost to COVID-19 globally. As of January 6, 2021, YLL in heavily affected countries are 2–9 times the average seasonal influenza; three quarters of the YLL result from deaths in ages below 75 and almost a third from deaths below 55; and men have lost 45% more life years than women. The results confirm the large mortality impact of COVID-19 among the elderly. They also call for heightened awareness in devising policies that protect vulnerable demographics losing the largest number of life-years.
Retailer Responses to Public Consultations on the Adoption of Takeaway Management Zones Around Schools: A Longitudinal Qualitative Analysis
Background: Takeaway food is often high in calories and served in portion sizes that exceed public health recommendations for fat, salt and sugar. This food is widely accessible in the neighbourhood food environment. As of 2019, of all local authorities in England (n = 325), 41 had adopted urban planning interventions that can allow them to manage the opening of new takeaway outlets in “takeaway management zones around schools” (known elsewhere as “exclusion zones”). Before adoption, local authorities undertake mandatory public consultation where responses objecting to proposals can be submitted. Evidence on common objections could be insightful for practitioners and policy-makers considering this intervention. Methods: We included 41 local authorities that adopted a takeaway management zone around schools between 2009 and 2019. We identified and analysed objections to proposals submitted by or on behalf of food retailers and local authority responses to these. We used reflexive thematic analysis with a commercial determinants of health lens to generate themes, and investigated if and how objections and responses changed over time. Results: We generated four themes: The role of takeaways in obesity, Takeaway management zone adoption, Use and interpretation of evidence, and managing external opinions. Despite not being implicated by the adoption of takeaway management zones around schools, planning consultants objected to proposals on behalf of transnational food retailers, however, independent takeaways did not respond. Objections attempted to determine the causes of poor diet and obesity, suggest alternative interventions to address them, undermine evidence justifying proposals, and influence perspectives about local authorities and their intervention. Objections consistently raised the same arguments, but over time became less explicit and expressed a willingness to partner with local authorities to develop alternative solutions. Conclusion: Objections to local authority proposals to adopt an urban planning intervention that can stop new takeaways opening near schools featured strategies used by other industries to delay or prevent population health intervention adoption. Practitioners and policy-makers can use our findings when developing proposals for new takeaway management zones around schools. By using knowledge about their local context and addressing arguments against specific aspects of the intervention, they can pre-empt common objections.
Planning guidance to limit hot food takeaways: Understanding the possible economic impacts
Local and national policymakers are seeking innovative solutions to create healthier food environments around the world. Between 2009 and 2017, 35 local authorities across England (UK) adopted planning guidance designed to limit the proliferation of hot food takeaways near schools. Whilst these policies are intended to improve population health, they are also likely to have economic impacts. Often a decision to introduce such policies comes down to consideration of whether the short-term economic imperatives of allowing new takeaway outlets to open outweighs the potential long-term public health implications and associated economic consequences. These potential negative and positive economic impacts have not previously been clearly described and are summarised here. The aim of this paper is to provide an overview of the potential economic impacts of takeaway management zones. In particular, we present a Causal Loop Diagram (CLD) that outlines the possible economic impacts of takeaway management zones based on researcher knowledge of the interventions and the industry. Potential negative impacts fall across sectors and may include a loss of employment opportunities and reductions in local and national tax receipts, and may impact the economic vitality of local communities. In the longer term, there is the potential for positive impacts such as reductions in healthcare resource utilisation, social care expenditure and sickness-related absence from work. Part of a robust case would a better economic understanding, that would enable local authorities to improve understanding of the trade-offs associated with the policy, such as short-versus long-term, and business-related versus society-related health benefits and costs.
Experiences of social prescribing in the UK: a qualitative systematic review.
BACKGROUND: Social prescribing connects patients to resources or activities to meet their non-medical needs. In the UK, it is often implemented in primary care. In the social prescribing pathway, patients are directed to link workers to identify suitable solutions for their needs such as art workshops or welfare benefit guidance. Social prescribing marks a notable transition from traditional medical treatments to more comprehensive strategies focusing on holistic health and wellbeing. Insights from patient experiences can improve the development of social prescribing to better meet their needs. This understanding can aid in improving the delivery and outcomes of social prescribing. AIM: To synthesise qualitative research on the experiences of social prescribing among patients in the UK. DESIGN AND SETTING: Qualitative systematic review using thematic synthesis for peer-reviewed studies that focused on experiences of users of social prescribing in the UK. METHOD: An exhaustive search was performed in six databases: ASSIA, CINAHL, Embase, MEDLINE, PsycINFO, and Social Sciences Citation Index via Web of Science. The Critical Appraisal Skills Programme tool for qualitative research was used for quality assessment and the PRISMA 2020 checklist was used to ensure the report transparency. RESULTS: Titles and abstracts of 1269 studies were screened. In total, 85 studies were full-text screened, and 19 studies were included in the review. Five analytical themes were developed from these studies: a) searching for hope in times of adversity; b) variability in temporal responsiveness; c) sustained change from a positive response; d) feeling supported and empowered by the social prescribing pathway; and e) misalignment producing no response. CONCLUSION: Patients might experience lasting advantages from social prescribing if it aligns with their needs and expectations. Results highlighted the importance of matching social prescribing referral with patients' readiness to engage. Therefore, it is recommended that healthcare professionals evaluate patient suitability before beginning a social prescribing referral.
Factors associated with link workers considering leaving their role: a cross-sectional survey.
BACKGROUND: Social prescribing (SP) link workers (LWs) listen to patients' concerns and difficulties, and connect them to relevant community assets (groups/organisations/charities) that can help with their non-medical issues (eg, loneliness, debt, housing). LW retention is key to sustaining SP within primary care. AIM: To examine occupational self-efficacy, job discrepancy and other factors as potential predictors of LWs' intentions to leave or remain in their post. DESIGN & SETTING: Cross-sectional survey involving LWs from the United Kingdom. METHOD: An online questionnaire was distributed via SP-related organisations. Questions were on: a) intention to leave the role, b) demographics, and c) role experience, including occupational self-efficacy and discrepancy between expectations and reality of the job. Questions were mainly closed, although some allowed LWs to provide a written response. Logistic regression models were fitted to identify predictors, and content analysis used to categorise open ended responses. RESULTS: 342 questionnaire responses were included in the analysis. Higher job discrepancy was associated with past (odds ratio [OR] per 30 unit increase=6.86; 95% CI: 3.91 to 12.0; P=0.003) and future (OR=4.86; 95% CI: 2.70 to 8.72; P<0.001) intentions to leave, whilst lower occupational self-efficacy was associated only with past intentions to leave (OR per 10 unit decrease=1.91; 95% CI: 1.24 to 2.93; P=0.003). CONCLUSION: Findings highlight factors influencing LW retention, offering a foundation for targeted interventions, which could include clearer communication about the role during recruitment, and adjusting job descriptions and support when required.
Challenges and barriers to physician decision-making for prescribing and deprescribing among patients with multimorbidity in eastern China's primary care settings: A qualitative study
Objectives Patients with multimorbidity have an increased risk of medication-related problems. Physicians face the dilemmas of multimorbidity management with multiple medications in primary care settings. We aimed to investigate the experiences and perceptions of primary care physicians (PCPs) regarding their decision-making processes in prescribing and deprescribing medications for patients with multimorbidity, and identify the challenges and barriers they face. Design From 5 October 2023 to 27 January 2024, this qualitative study was conducted through semi-structured interviews that encouraged in-depth exploration of the participants' experiences and perspectives. The interviews were audio-recorded, transcribed verbatim, and independently coded by two investigators. Themes were developed using a conventional content analysis approach. Setting 12 community health centers and 8 township health centers across four regions in eastern China were included. Participants 26 PCPs from 20 primary care institutions in eastern China were interviewed through purposive sampling, representing a mix of urban and rural healthcare settings. Results Of the 26 participants in this study, 14 (53.8%) were women, and the mean age was 36.3 years old. When prescribing and stopping medications for patients with multimorbidity, they often encounter complex challenges. These challenges stemmed from three key areas: (1) difficulties in identifying drug-disease and drug-drug interactions; (2) cognitive biases in medication benefit-risk evaluation and (3) heavy treatment burden. The challenges were further compounded by multiple barriers, including clinical inertia among physicians, patient resistance to medication changes, inadequate decision support and training, and time constraints in clinical consultation. Conclusions The complexity of prescribing and deprescribing decisions faced by PCPs in treating patients with multimorbidity in China is influenced by interconnected factors related to physicians, patients, technology and working environment. Future research could develop and evaluate implementation strategies to address specific challenges and barriers to allow PCPs to make effective medication decisions for patients with multimorbidity.