Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme

The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP | BMC Cancer

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The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

Full reference: Smith, S.G. et al. (2017) Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer. 17:543

North-South health divide bigger than ever with alarming rise in deaths of northern 25-44 year olds

Dying early (under age 75) is 20% more likely in northern compared with southern England according to research led by The University of Manchester

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The study uncovers a North-South divide in deaths among middle aged adults, which has been rising since the mid-90s and is now at alarming levels:

  • 49% more deaths among 35-44 year olds in the North in 2015
  • 29% more deaths among 25-34 year olds in the North in 2015

The team shows that a sharp increase in premature deaths among middle aged adults in the North first emerged in the mid-90s, increasingly quickly but consistently until the end of the study period in 2015.

A comprehensive approach to reablement in dementia

As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence | Alzheimer’s & Dementia

This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support.

In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors.

Full reference: Poulos, C.J. et al. (2017) A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia. Published online: 28 July 2017

 

Impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures

Inadequate health literacy (HL) is associated with impaired healthcare choices leading to poor quality-of-care | Geriatric Nursing

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Our primary purpose was to estimate the prevalence of inadequate HL among two populations of AARP®Medicare Supplement insureds: sicker and healthier populations; to identify characteristics of inadequate HL; and to describe the impact on patient satisfaction, preventive services, healthcare utilization, and expenditures. Surveys were mailed to insureds in 10 states. Multivariate regression models were used to identify characteristics and adjust outcomes. Among respondents (N = 7334), 23% and 16% of sicker and healthier insureds, respectively, indicated inadequate HL. Characteristics of inadequate HL included male gender, older age, more comorbidities, and lower education. Inadequate HL was associated with lower patient satisfaction, lower preventive service compliance, higher healthcare utilization and expenditures. Inadequate HL is more common among older adults in poorer health, further compromising their health outcomes; thus they may benefit from expanded educational or additional care coordination interventions.

Full reference: MacLeod, S. et al. (2017) The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatric Nursing. Volume 38 (Issue 4) pp. 334–341

Child under nutrition project: A report about the current undernourishment of children in England

Patients Association, July 2017

TChild Nutritionhe Patients Association has issued a report suggesting that under-nutrition among children is not confined to the developing world, but is a problem in Britain today.

The project was undertaken by the Patients Association and funded by a non-restricted education grant from Abbott. A cross-section of health and care staff in four sites – Bradford, Cornwall, Tower Hamlets and Birmingham – were interviewed. Parents were also interviewed in Bradford and Cornwall.

The findings reveal examples of positive efforts in working with children and families across agencies, particularly by public health teams, community and acute health staff; but many are overstretched and unable to meet demand for the types of information and guidance that people need. The report’s recommendations include:

  • Awareness of under-nutrition should be raised among both professionals and the public
  • New and existing training and guidance for professionals should include the identification and treatment of under-nutrition
  • National guidance and a care pathway should be developed specifically for undernutrition.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, et al. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. Programme Grants Appl Res 2017;5(14)

Burns, scalds, falls and poisoning are major causes of death, disability and health service use in the under-fives. We undertook 13 studies to explore factors associated with injuries, what prevents injuries, the cost of the injuries to the NHS and parents, and what parents and children’s centres (which provide families with information, support and co-ordinated services from a range of professionals) were doing to prevent injuries.

We used evidence from these studies to design a resource [an injury prevention briefing (IPB)] for children’s centres to use with parents for preventing house fire injuries. We gave 12 children’s centres the IPB, with training and support to implement it, (IPB+ group) and 12 centres the IPB without training or support (IPB-only group). A further 12 centres were not given the IPB (usual-care group). Children’s centres in both IPB groups used the IPB and increased injury prevention activity, more markedly in the IPB+ centres. The IPB did not increase how many families had a fire escape plan in either IPB group, but did increase some fire escape behaviours in both groups. Providing the IPB without training and support cost less and was slightly more effective than not providing the IPB. Providing the IPB with training and support cost more but was only slightly more effective than not providing the IPB. Children’s centres can increase some fire safety behaviours in families with young children if they are provided with evidence-based resources such as the IPB. A further IPB has been produced for the prevention of fire-related injuries, falls, poisonings and scalds.

Royal College of Paediatrics and Child Health: Position Statement on breastfeeding in the UK

Royal College of Paediatrics and Child Health, August 2017

This reportBaby's Healthcare highlights that the UK has one of the lowest rates of breastfeeding in Europe, and only 34% of babies are receiving some breast milk at 6 months. Recommendations include development of a national strategy to change negative societal attitudes to breastfeeding