Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study.

BACKGROUND: Objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. PARTICIPANTS: Two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample. METHODS: Socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded. ANALYSES: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease. RESULTS: For every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44-0.91, P=0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04-2.68, P=0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98-2.05, P=0.045) were associated with diagnoses of more new diseases. CONCLUSION: Physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development.

Developing the public health workforce: training and recognizing specialists in public health from backgrounds other than medicine: experience in the UK.

BACKGROUND: There is increasing recognition that improving health and tackling inequalities requires a strong public health workforce capable of delivering key public health functions across systems. The World Health Organization in Europe has identified securing the delivery of the Essential Public Health Operations and strengthening public health capacities within this as a priority.It is acknowledged that current public health capacities and arrangements of public health services vary considerably across the World Health Organization in European Region, and investment in multidisciplinary workforce with new skills is essential if public health services are to be delivered. CASE PRESENTATION: This paper describes the current situation in the UK where there are nationally funded multidisciplinary programmes for training senior public health specialists. Uniquely, the UK provides public health registration for multidisciplinary as well as medical public health specialists. CONCLUSION: The transition from a predominantly medical to a multidisciplinary public health specialist workforce over a relatively short timescale is unprecedented globally and was the product of a sustained period of grass roots activism aligned with national policy innovation. the UK experience might provide a model for other countries seeking to develop public health specialist workforce capacity in line with the Essential Public Health Operations.

Intravenous drug users and broken needles--a hidden risk?

AIMS: To determine the frequency with which intravenous drug users (IDUs) experience broken needles during their injecting careers. DESIGN: Cross-sectional survey. PARTICIPANTS: Seventy intravenous drug users held in police custody in Bristol between May and September 2002. MEASUREMENTS: Self-reported history of experience of broken needles. FINDINGS: Fourteen (20%, 95% CI 11-29%) had experienced a needle breaking while injecting. The total number of broken needles was 23, of which 14 (61%) were recovered, four by surgical intervention, and the remainder as a result of direct action by the individual. Of the 23 broken needles, nine (39%) were reported to be fresh needles, whereas the remainder were being re-used. CONCLUSIONS: IDUs may well experience, directly or indirectly, incidents involving broken needles during the course of their injecting careers. Given the potential for embolization and the risk of subsequent complications when this occurs, we recommend that harm minimization guidance should include advice about this potential hazard and the need for early action to retrieve broken needles.