Characterizing asset-based studies in public health: development of a framework.

Asset-based approaches are becoming more common within public health interventions; however, due to variations in terminology, it can be difficult to identify asset-based approaches. The study aimed to develop and test a framework that could distinguish between asset-based and deficit-based community studies, whilst acknowledging there is a continuum of approaches. Literature about asset-based and deficit-based approaches were reviewed and a framework was developed based on the Theory of Change model. A scoring system was developed for each of the five elements in the framework based on this model. Measurement of community engagement was built in, and a way of capturing how much the study involved an asset approach. The framework was tested on 13 studies examining community-based interventions to investigate whether it could characterize asset-based versus deficit-based studies. The framework demonstrated how much the principles underpinning asset-based approaches were present and distinguished between studies where the approach was deficit-based to those that had some elements of an asset-based approach. This framework is useful for researchers and policymakers when determining how much of an intervention is asset-based and identifying which elements of asset-based approaches lead to an intervention working.

Deficit-based approaches are a common approach to addressing public health issues within a community and involve identifying a health problem or need and finding a way to solve these. However, asset-based approaches, those that involve the community using its assets, or strengths, to enable community members to have more control over their health and wellbeing, are increasingly common. The terminology used to describe these methods varies greatly so it can be difficult to identify whether an approach is more deficit-based or asset-based. To address this a framework was developed to identify and score elements of asset-based studies. We did this by reviewing academic information describing asset-based approaches and built into this a scoring system. This framework was used to assess and measure the degree to which 13 community-based studies took an asset-based approach. The framework was able to identify studies which were more asset-based in their approach compared to those which were more deficit-focused, acknowledging that some studies may have elements of each approach. This framework will be useful for people working in health policy and research who want a resource to help identify asset-based approaches in practice and which aspects of the approach were important for its success in the community.

A conformational constraint improves a beta-secretase inhibitor but for an unexpected reason.

During our ongoing efforts to develop a small molecule inhibitor targeting the beta-amyloid cleaving enzyme (BACE-1), we discovered a class of compounds bearing an aminoimidazole motif. Initial optimization led to potent compounds that have high Pgp efflux ratios. Crystal structure-aided design furnished conformationally constrained compounds that are both potent and have relatively low Pgp efflux ratios. Computational studies performed after these optimizations suggest that the introduction of the constraint enhances potency via additional hydrophobic interactions rather than conformational restriction.

Discovery of aminoheterocycles as a novel beta-secretase inhibitor class: pH dependence on binding activity part 1.

We have developed a novel series of heteroaromatic BACE-1 inhibitors. These inhibitors interact with the enzyme in a unique fashion that allows for potent binding in a non-traditional paradigm. In addition to the elucidation of their binding profile, we have discovered a pH dependent effect on the binding affinity as a result of the intrinsic pK(a) of these inhibitors and the pH of the BACE-1 enzyme binding assay.

Utilizing Low-Volume Aqueous Acoustic Transfer with the Echo 525 to Enable Miniaturization of qRT-PCR Assay.

Quantitative reverse transcription PCR (qRT-PCR) is a valuable tool for characterizing the effects of inhibitors on viral replication. The amplification of target viral genes through the use of specifically designed fluorescent probes and primers provides a reliable method for quantifying RNA. Due to reagent costs, use of these assays for compound evaluation is limited. Until recently, the inability to accurately dispense low volumes of qRT-PCR assay reagents precluded the routine use of this PCR assay for compound evaluation in drug discovery. Acoustic dispensing has become an integral part of drug discovery during the past decade; however, acoustic transfer of microliter volumes of aqueous reagents was time consuming. The Labcyte Echo 525 liquid handler was designed to enable rapid aqueous transfers. We compared the accuracy and precision of a qPCR assay using the Labcyte Echo 525 to those of the BioMek FX, a traditional liquid handler, with the goal of reducing the volume and cost of the assay. The data show that the Echo 525 provides higher accuracy and precision compared to the current process using a traditional liquid handler. Comparable data for assay volumes from 500 nL to 12 µL allowed the miniaturization of the assay, resulting in significant cost savings of drug discovery and process streamlining.

What if my back breaks? Making sense of musculoskeletal pain among South Asian and African-Caribbean people in the North West of England.

OBJECTIVES: The pain and disability, which arise as a result of musculoskeletal conditions, have been central to theories and understanding about chronic illness. However, little attention has been paid to the experience of such pain amongst ethnic minority groups. In this paper, we explore Asian and African-Caribbean respondents' ideas about the nature of and management of widespread pain. METHODS: Our data are drawn from a qualitative study linked to an epidemiological study of musculoskeletal symptoms undertaken in the North West of England. In-depth interviews were carried out with 32 people. Themes identified from the data were causes of symptoms, experience of pain, primary care utilisation and self-management. RESULTS: For both African-Caribbean and South Asian populations widespread pain was reported more frequently than a general population sample residing in the same locality. However, notions of the experience and management of widespread pain differed. Accounts of pain from the African-Caribbean respondents coincided with a traditional Western medical model of psychogenic pain and individualised coping strategies. Descriptions from some South Asian respondents suggested a lack of demarcation between pain located in specific parts of the body and broader social and personal concerns and an unwillingness to recognise the latter as "depression" or psychological distress. Help from family members was referred to more than individual strategies of managing pain. CONCLUSIONS: Differences in the experience of musculoskeletal has relevance for understanding the way in which psychosocial distress is manifested and managed in primary care.

Health of caravan park residents: a pilot cross-sectional study in the East Riding of Yorkshire.

Long-stay coastal caravan communities are common in Britain and anecdotal evidence suggests a high level of socio-economic deprivation, and substantial health needs. A pilot cross-sectional study of English caravan communities in Yorkshire found very high rates of poor health and limiting long-term illness compared with regional and national data and exceeding rates explained by demography and deprivation alone. These insights into previously overlooked health inequalities warrant concern and merit further research and intervention to address them. The study also demonstrates the feasibility of our methodology in these hard-to-reach coastal caravan communities.

Opportunities for prevention of 'clinically significant' knee pain: results from a population-based cross sectional survey.

BACKGROUND: There is little UK-based evidence on the prevalence and predictors of knee pain associated with disability across all adult ages. We aimed to estimate the prevalence of 'clinically significant' knee pain, identify and assess the population impact of independent risk factors, and estimate levels of healthcare need. METHODS: A cross-sectional survey of three general practice populations was conducted. Adults (n = 5752) were mailed a screening questionnaire (phase I). Those reporting predominant or isolated knee pain were sent a detailed questionnaire (phase II), with a further sub-sample invited for clinical examination (phase III). Logistic regression was used to identify independent risk factors and population attributable fractions were calculated. RESULTS: The 1 month period prevalence of 'all reported' knee pain was 19 per cent, of which about a third was disabling and a fifth intense and disabling. Obesity, deprivation and South Asian ethnicity were each associated with a 3-4-fold increased risk of knee pain with disability (after age/sex adjustment). The attributable fraction estimate for raised body mass index (BMI) was 36 per cent (27-44 per cent) - the population impact of being overweight was greater than that of being obese. Thirteen per cent of all adults reported a previous primary care consultation, 7 per cent reported previous secondary care referral for knee pain, and 4.5 per cent (2.7-6.2 per cent) of the adult population were currently receiving or in need of specialist treatment. CONCLUSION: The high population impact of being overweight (BMI 25-29) or obese (BMI 30 or more) has implications for primary prevention. The estimates of previous healthcare usage, and of levels of met and unmet need, are useful for healthcare planning.

Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population.

STUDY DESIGN: Multiphase cross-sectional survey of musculoskeletal pain. OBJECTIVES: To estimate the prevalence of all reported and clinically significant spinal pain. To identify independent predictors of spinal pain. METHODS: A total of 5752 adults sampled from three general practice registers were mailed a screening questionnaire. Subjects who reported the spine as a predominant site of pain were sent a site-specific questionnaire (i.e., back or neck) that asked about severity. Prevalence estimates were calculated and extrapolated to the general population. Predictors of spinal pain were identified using logistic regression with comprehensive adjustment for confounders (including pain at other anatomic sites). RESULTS: The 1-month-period prevalence of all reported spinal pain was 29% (95% confidence interval 27-31%), of which about half was intense, half was chronic, 40% was disabling, and 20% was intense, disabling, and chronic. Most people with back (75%) or neck (89%) pain also reported pain at other sites. Age, female gender (neck pain only), high body mass index, living in an area of raised material deprivation, and south Asian ethnicity were significant predictors of spinal pain with disability. The association between body mass index and deprivation and neck pain was lost after adjustment for pain at other sites. However, even after full adjustment, obesity (OR, 1.7; 95% confidence interval, 1.1-2.5) and high deprivation (OR, 1.7; 95% confidence interval, 1.1-2.7) were predictors of back pain with disability. CONCLUSIONS: Adjustment for pain at other sites enabled assessment of whether observed associations were with spinal pain itself or with the other sites of pain. Obesity is an important independent predictor of back pain and its severity. This has implications for primary prevention. The prevalence of spinal pain with disability continues to rise into old age. This has implications for healthcare planning.