Objective To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions. Design A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation. Setting A deprived district in the North West of England between 2005 and 2016. Intervention A community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016. Main outcome measures Emergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD. Results The intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3). Conclusion We found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.
Background: Previous studies exploring risk-taking behaviour on holiday are typically limited to single nationalities, confounding comparisons among countries. Here we examine the sexual behaviour of holidaymakers of three nationalities visiting Ibiza and Majorca. Methods: A comparative cross-sectional study design was used focusing on British, Spanish and German holidaymakers in the age range of 16–35 years. Overall, 3003 questionnaires were gathered at airports in Majorca and Ibiza from holidaymakers returning home. Results: Of those surveyed, 71.1% were single (travelling without a current sexual partner) (Majorca, 74.3%; Ibiza, 68.0%). Overall, 34.1% of single holidaymakers had sex on holiday. Amongst single participants, factors associated with having sex on holiday were high levels of drunkenness, being Spanish and holidaying for over 2 weeks. Of those single and having sex on holiday, factors associated with multiple sexual partners were being male and age ≤19 years. Unprotected sex was predicted by being German and holidaying in Majorca, holidaying with members of the opposite sex and using four or more drugs on holiday. All sexual behaviours were predicted by a high number of sexual partners in the previous 12 months. Furthermore, single holidaymakers having sex abroad were more likely to prefer night-time venues facilitating casual sex and excessive alcohol consumption. Conclusions: Casual sex encounters in youth holiday resorts may be commonplace and mediated through substance use. Further focused public health efforts, including in bars/nightclubs, are needed to prevent sexual risk-taking which can increase the likelihood of poor sexual health outcomes and associated factors such as regretted sex.
S ummary . Previous research has indicated that children enter the task of learning to read in a state of cognitive confusion regarding the function and nature of the task. The present investigation was addressed to the hypothesis that cultural differences in home background are an important influence in the development of children's understanding of the purpose of writing and their concepts of the language units employed in the written code. 92 non‐Indian Canadian children at kindergarten were compared with 72 kindergarten pupils from two Indian bands in which there is no tradition of literacy and a poverty of experiences of writing and formal concern with language analysis. On all five measures used the Indian children scored significantly lower. They were less able to recognise literacy activities, less cognisant of their purpose, and had poorer technical knowledge of units of speech and writing.
Adolescent health is a growing concern. High rates of binge drinking and teenage pregnancies, documented in the UK, are two measures defining poor wellbeing. Improving wellbeing through schools is a priority but information on the impact of wellbeing on alcohol use, and on sexual activity among schoolchildren is limited. A cross-sectional survey using self-completed questionnaires was conducted among 3,641 schoolchildren aged 11-14 years due to participate in a sex and relationships education pilot programme in 15 high schools in North West England. Bivariate and multivariate analyses were conducted to examine the relationship between wellbeing and alcohol use, and wellbeing and sexual activity. A third of 11 year olds, rising to two-thirds of 14 year olds, had drunk alcohol. Children with positive school wellbeing had lower odds of ever drinking alcohol, drinking often, engaging in any sexual activity, and of having sex. General wellbeing had a smaller effect. The strength of the association between alcohol use and the prevalence of sexual activity in 13-14 year olds, increased incrementally with the higher frequency of alcohol use. Children drinking once a week or more had 12-fold higher odds of any sexual activity, and 10-fold higher odds of having sex. Rare and occasional drinkers had a significantly higher odds compared with non-drinkers. The relationship between wellbeing and alcohol use, and wellbeing and sexual activity reinforces the importance of initiatives that enhance positive wellbeing in schoolchildren. The association between alcohol use and sexual activity highlights the need for integrated public health programmes. Policies restricting alcohol use may help reduce sexual exposure among young teenagers.
BACKGROUND Remote care technology can bridge the gap between healthcare and community settings, provide more continuous and frequent monitoring of the disease process, and aid in self-care. A common barrier however is the lack of patient engagement with remote care technologies. OBJECTIVE This discrete choice experiment elicits the preferences of heart failure patients with regard to remote care technologies, and in turn, creates a hierarchy of factors that can affect engagement. METHODS A discrete choice experiment survey was designed with input from a patient group. The experimental attributes were based on five central themes (each of which had positive and negative levels): communication, clinical care, education, ease of use, and convenience. The survey allowed participants to trade attributes according to their preferences. The survey was distributed to 93 participants with heart failure. The results were analysed using binary logit to obtain preference weights for each attribute. RESULTS The binary logit created coefficients for each attribute, all of which were significant (p<0.01), and which equated to the relative preference of the associated themes: clinical care (2.022), education (1.252), convenience (1.245), ease of use (1.155) and communication (1.040). The most preferred factor, clinical care, had enough value to be traded for approximately any two other factors. Communication was the least preferred attribute. CONCLUSIONS Technology designers can use the associated preference weights to determine the relative increase of value perceived by patients by adding in certain attributes, and thus increase engagement from patients most likely to benefit from remote care.
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