Using care and support planning to implement routine falls prevention and management for people living with frailty: A qualitative evaluation.

BACKGROUND: Frailty is a key issue in current healthcare delivery and falls is an important component. Care and support planning (CSP) is an established approach to managing long term conditions (LTCs) and has potential to provide more person-centred care for those at risk of falling. This qualitative evaluation aimed to understand the barriers and success criteria involved in incorporating falls assessment and management into the CSP process. METHODS: CSP for falls prevention was implemented in eight general practices in the North of England. Six of the eight practices participated in the qualitative evaluation. Seven group interviews were undertaken with staff (n = 31) that included practice nurses, health care assistants, nurses, and administrative staff (n = 2-8 per group). Observations of the falls and CSP training provided additional data. Interviews covered experiences and potential impacts of training, and processes of implementation of the programme, and were informed by normalisation process theory. Thematic analysis was undertaken using a team-based approach. RESULTS: Although successfully implemented across the practices, how established CSP was and therefore 'organisational readiness' was an overarching theme that illustrated differences in how easily sites were able to implement the additional elements for frailty. The challenges, successes and impacts of implementation are demonstrated through this theme and four further themes: training resources and learning; positive impacts of the programme (including enabling easier conversations around 'frailty'); integrating work processes/work with patients; and dealing with uncertainty and complexity. CONCLUSIONS: Care and Support Planning services designed to target frailty and falls is feasible and can successfully be delivered in the primary care setting, if key enablers are promoted and challenges to implementation addressed from planning through to integration in practice.

The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. PARTNERSHIP: The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders. CONCLUSION: We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.

Alcohol consumption among university students in the night-time economy in the UK: A three-wave longitudinal study.

BACKGROUND: Excessive alcohol consumption is commonly reported in university/college students, and contributes to emerging peer-group relations. PURPOSE: This study aimed to provide up-to-date longitudinal data on students' alcohol consumption patterns, and predictors of this, across a single academic year. METHODS: A 3-wave study was conducted at a university in the UK. Participants reported their alcohol consumption patterns, along with perceptions of the social norms and behavioral expectations associated with attending licensed venues where alcohol is sold (the "night time economy"). Participants also reported their social identification with this environment. RESULTS: Around half of participants overall fell into the three higher alcohol-risk categories (moderate, high or hazardous drinking). A modest reduction in consumption was observed across the study. At each assessment point, males reported greater alcohol consumption in the preceding two months than females, while Year 4 students and those on graduate-entry programs reported the lowest consumption. Excessive alcohol consumption was regarded as largely normative within the night time economy, both descriptively ("what others do") and injunctively ("what others approve of"). Social identification and norm perceptions, along with gender, year group, and intoxication and socialising expectations, were significantly associated with higher alcohol consumption at baseline. However, baseline consumption was the only variable significantly associated with alcohol use at the end of the academic year. CONCLUSIONS: Many students drink alcohol at potentially harmful levels, and norms and expectations supporting this consumption are prominent and stable. The findings support a targeted approach to intervention that accounts for heterogeneity in the student population.

High coverage of hepatitis B vaccination and low prevalence of chronic hepatitis B in migrant children dictate a new catch-up vaccination strategy.

BACKGROUND: Worldwide coverage of hepatitis B (HB) vaccination is increasing. This should be considered when determining the best strategy for catch-up HB vaccination in migrant children, who rarely have written proof of past immunizations. This study aimed to estimate HB vaccine protection, chronic HB prevalence and to identify determinants of vaccine protection. METHODS: Newly arrived migrant children at Lausanne University Hospital from October 2014 to July 2017 were prospectively enrolled. Children and adolescents aged 1-18 years were approached for inclusion if they had no proof of past vaccinations and accepted a single dose of injected HB vaccine. HB surface antibody (anti-HBs) serology was performed after 4-6 weeks. Anti-HBs ≥100 IU/L were considered consistent with a booster-type antibody response. Patients with anti-HBs <100 IU/L received additional dose(s) of HB vaccine, after exclusion of chronic HB in children with anti-HBs <10 IU/L. Potential determinants of vaccine response were compared between children with and without booster-type response. RESULTS: Two hundred children were available for analysis. Median age was 8.9 years (IQR 4.8-12.9), and 97 (49%) were female. The majority (n = 124, 62%) came from the region classified by the WHO as eastern Mediterranean. One hundred and sixty-one children (81%) had a booster-type antibody response. Only 1 patient (<1%) had chronic HB. In the multivariate analysis, younger age (OR per decreasing-year, 1.28; 95%CI, 1.05-1.57; p = 0.017) and migration from an urban area (OR 1.16; 95%CI, 1.01-1.33; p = 0.043) were the only significant determinants of booster-type response. CONCLUSION: Post-vaccine serology may be used to identify a high proportion of individuals in our pediatric migrant population with previous immunization for HB. Our study also showed extremely low prevalence of chronic HB. No variable could definitively determine the results of serology. Post-vaccine serology represents the most effective strategy in this context of high vaccine coverage.

The association between the density of retail tobacco outlets, individual smoking status, neighbourhood socioeconomic status and school locations in New South Wales, Australia.

AIM: We explored the association between the density of tobacco outlets and neighbourhood socioeconomic status, and between neighbourhood tobacco outlet density and individual smoking status. We also investigated the density of tobacco outlets around primary and secondary schools in New South Wales (NSW). METHODS: We calculated the mean density of retail tobacco outlets registered in NSW between 2009 and 2011, using kernel density estimation with an adaptive bandwidth. We used generalised ordered logistic regression model to explore the association between socioeconomic status and density of tobacco outlets. The association between neighbourhood tobacco outlet density and individuals' current smoking status was investigated using random-intercept generalised linear mixed models. We also calculated the median tobacco outlet density around NSW schools. RESULTS: More disadvantaged Census Collection Districts (CDs) were significantly more likely to have higher tobacco outlet densities. After adjusting for neighbourhood socioeconomic status and participants' age, sex, country of birth and Aboriginal status, neighbourhood mean tobacco outlet density was significantly and positively associated with individuals' smoking status. The median of tobacco outlet density around schools was significantly higher than the state median. CONCLUSION: Policymakers could consider exploring a range of strategies that target tobacco outlets in proximity to schools, in more disadvantaged neighbourhoods and in areas of existing high tobacco outlet density.

User experience of interRAI assessment tools in New Zealand.

The international residential assessment instrument (interRAI) has been adopted for phased national implementation in New Zealand. It targets people over 65 years who require needs assessment for access to long term publicly funded services. There is limited research on the barriers to adoption for interRAI electronic assessment tools, and none relating to the New Zealand health sector. This research qualitatively explored clinicians' perceptions and experience of using interRAI electronic assessment tools using semi-structured interviews guided by constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT) model [9]. Analysis was conducted using thematic analysis. Three major barriers to adoption of interRAI tools emerged from the research: 1) lack of ready access to individual laptops/computers with consistent network connectivity, 2) need for ongoing training for interRAI assessors, and, 3) lack of understanding of what information is being collected and for what reasons. The growth in aging populations will see greater use of interRAI electronic assessment tools, and therefore more clinicians required to learn and use the technology. Addressing these barriers to adoption is therefore vital.

Effectiveness of Australia's Get Healthy Information and Coaching Service: maintenance of self-reported anthropometric and behavioural changes after program completion.

BACKGROUND: The Get Healthy Information and Coaching Service (GHS) is a population-wide telephone-based program aimed at assisting adults to implement lifestyle improvements. It is a relatively uncommon example of the translation of efficacious trials to up-scaled real-world application. GHS participants who completed the 6-month coaching program made significant initial improvements to their weight, waist circumference, Body Mass Index (BMI), physical activity and nutrition behaviours. This study examines the maintenance of anthropometric and behaviour change improvements 6-months after program completion. METHODS: GHS coaching participants (n=1088) were recruited between February 2009 and June 2011. Participants were eligible if they completed the 6-month coaching program and had available data at 12-month follow-up (n=277). Weight, waist circumference, BMI, fruit and vegetable consumption and physical activity were collected at baseline and 6-months by GHS coaches and 12-months (6-months post program) by independent evaluators. Matched pair t-tests, mixed linear regression and logistic regression analyses were performed to assess maintenance of program effects. RESULTS: Improvements in weight (-2.9 kg, 95% CI: -3.6, -2.1), waist circumference (-5.4 cm, 95% CI: -6.7, -4.1), BMI (-1.1 units, 95% CI: -1.5, -0.8), and fruit (+0.3 serves per day, 95% CI: 0.2, 0.3) and vegetable (+0.5 serves per day 95% CI: 0.3, 0.6) consumption were observed from baseline to 12-months. Apart from vegetable consumption, there were no significant differences between 6-month and 12-month changes from baseline, indicating these risk factor improvements were maintained from the end of the coaching program. There were also improvements in the proportion of participants undertaking recommended levels of physical activity from baseline to 12-months (increase of 5.2%), however the improvements made at end of the coaching program were not maintained at the 6-month follow up. CONCLUSIONS: This study provides preliminary evidence that the GHS has potential to contribute to substantial improvements in the chronic disease risk factor profile of program completers and facilitates sustained maintenance six months after completing the coaching program.

Non-exercise physical activity in agricultural and urban people.

With evidence that urbanisation is associated with obesity, diabetes, hypertension and cardiovascular disease, this article compares daily physical activity between rural and urban dwellers. Specifically, it examines habitual daily activity levels, non-exercise activity thermogenesis (NEAT) and energy expenditure in agricultural and urban Jamaicans and urban North Americans. Ambulation was 60 per cent greater in rural Jamaicans than in the urban dwellers (4675 ± 2261 versus 2940 ± 1120 ambulation-attributed arbitrary units (AU)/day; P = 0.001). Levels of ambulation in lean urban Jamaicans were similar to those in lean urban North Americans, whereas obese urban dwellers walked less than their lean urban counterparts (2198 ± 516 versus 2793 ± 774 AU/day; P = 0.01). The data with respect to daily sitting mirrored the walking data; obese Americans sat for almost four hours more each day than rural Jamaicans (562 ± 78 versus 336 ± 68 minutes/day; P < 0.001). Urbanisation is associated with low levels of daily activity and NEAT.

The strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011-2015; translating research into policy and practice.

With our rapidly ageing population there is an urgent imperative to minimise the rate of falls and associated injuries. A key challenge to public health is to better conceptualise and contextualise falls prevention evidence for more effective policy making and practice. This paper describes how NSW Health adopted the Nutbeam and Bauman Stages of Research and Evaluation Model in the strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011-2015. Research evidence has been comprehensively applied to every stage of the development of the Plan and research and evaluation is a key action area within the new Plan. The Stages of Research and Evaluation Model provides a useful overarching framework for policy makers to contextualise and more effectively apply research evidence throughout the policy making process from problem definition to program monitoring.