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Lock K, Hamilton C. P233 Adherence of nebuliser use in children with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Michael V, Warraich S, Lock K, Lewington P. P255 Transitioning to adult services for children with cystic fibrosis (CF): what matters to all stakeholders? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shayle A, Lock K. WS20.02 Input supporting a young person with increased cough suppression in the context of COVID-19. J Cyst Fibros 2022. [PMCID: PMC9184771 DOI: 10.1016/s1569-1993(22)00268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hu M, Lock K, Polychronakis T, McShane D. WS10.06 Adherence to nebulised medication in paediatric patients with cystic fibrosis following introduction of modulator therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fairbrother H, Crowder M, Dodd-Reynolds C, Egan M, Er V, Goyder E, Griffin N, Holding E, Lock K, Scott S, Summerbell C, Woodrow N. Exploring young people's perspectives of inequalities in health: a qualitative study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Reducing inequalities in health is an enduring global public health challenge. Worryingly in England, inequalities across some groups and places are worsening, highlighted and exacerbated by the Covid-19 pandemic. While there has been growing interest in exploring public understandings of health inequalities, few studies have explored the views of young people. Our study seeks to redress this by exploring young people's perspectives of inequalities in health.
Methods
Working with existing youth organisations, we recruited young people (aged 13-21) from six youth groups in areas of high deprivation across three geographical locations in England. Each group took part in three interlinked focus groups (n = 18), the majority of which were run online using video conferencing platforms. Focus groups were co-delivered with partnering youth organisations during 2021. They involved participatory concept mapping activities, and the discussion of health related news articles.
Results
Key themes emerged around young people's perspectives of: i) factors influencing health within their local area; ii) understandings of inequalities in health; and iii) key messages to convey to those with a role in addressing health inequalities at a place level.
Conclusions
Our study highlights the importance of exploring and understanding young people's perspectives of inequalities in order to better shape policies which are supported by the communities and people they impact.
Key messages
Young people have a nuanced, experiential understanding of key factors influencing their health and inequalities in health within their local areas. Building upon young people’s understandings of inequalities in health provides opportunities to mobilise support for policies seeking to change the distribution of key social determinants.
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Lowndes L, Hamilton C, Lock K, McShane D. P297 Change in 6-minute exercise test in children with cystic fibrosis admitted for intravenous antibiotics and physiotherapy. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pliakas T, Lock K, Jones A, Aalders S, Egan M. Getting shops to voluntarily stop selling cheap, strong beers and ciders: a time-series analysis evaluating impacts on alcohol availability and purchasing. J Public Health (Oxf) 2019; 41:110-118. [PMID: 29447371 DOI: 10.1093/pubmed/fdy003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/13/2017] [Accepted: 01/09/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 'Reducing the Strength' (RtS) is a public health initiative encouraging retailers to voluntarily stop selling cheap, strong beers/ciders (≥6.5% alcohol by volume). This study evaluates the impact of RtS initiatives on alcohol availability and purchasing in three English counties with a combined population of 3.62 million people. METHODS We used a multiple baseline time-series design to examine retail data over 29 months from a supermarket chain that experienced a two-wave, area-based role out of RtS: initially 54 stores (W1), then another 77 stores (W2). We measured impacts on units of alcohol sold (primary outcome: beers/ciders; secondary outcome: all alcoholic products), economic impacts on alcohol sales and substitution effects. RESULTS We observed a non-significant W1 increase (+3.7%, 95% CI: -11.2, 21.0) and W2 decrease (-6.8%, 95% CI: -20.5, 9.4) in the primary outcome. We observed a significant W2 decrease in units sold across all alcohol products (-10.5%, 95% CI: -19.2, -0.9). The direction of effect between waves was inconsistent for all outcomes, including alcohol sales, with no evidence of substitution effects. CONCLUSIONS In the UK, voluntary RtS initiatives appear to have little or no impact on reducing alcohol availability and purchase from the broader population of supermarket customers.
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Mothojakan N, Ahmed K, Lock K, Antoni E, Gardezi S, Ashraf S, Chandio K, Patel P, Arnold Jellis J, S-C. Soo D. Malnutrition screening on admission and initial management at a district general hospital. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Vocht F, Heron J, Mooney J, Angus C, Lock K, Egan M, Campbell R, Brennan A, Hickman M. P66 Cross-sectional and longitudinal associations between alcohol licensing policies, outlet density and deprivation and population health and crime in England. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morgan EH, Vatucawaqa P, Snowdon W, Worsley A, Dangour AD, Lock K. Factors influencing fruit and vegetable intake among urban Fijians: A qualitative study. Appetite 2016; 101:114-8. [PMID: 26952559 DOI: 10.1016/j.appet.2016.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/13/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
Low fruit and vegetable intake is an important risk factor for micronutrient deficiencies and non-communicable diseases, but many people worldwide, including most Fijians, eat less than the World Health Organization recommended amount. The present qualitative study explores factors that influence fruit and vegetable intake among 57 urban Fijians (50 women, 7 men) of indigenous Fijian (iTaukei) and South Asian (Indian) descent. Eight focus group discussions were held in and around Suva, Fiji's capital and largest urban area, which explored motivation for eating fruit and vegetables, understandings of links to health and disease, availability and sources, determinants of product choice, and preferred ways of preparing and eating fruit and vegetables. Data were analysed using thematic content analysis. Regardless of ethnicity, participants indicated that they enjoyed and valued eating fruit and vegetables, were aware of the health benefits, and had confidence in their cooking skills. In both cultures, fruit and vegetables were essential components of traditional diets. However, increasing preferences for processed and imported foods, and inconsistent availability and affordability of high-quality, low-priced, fresh produce, were identified as important barriers. The findings indicate that efforts to improve fruit and vegetable intake in urban Fijians should target the stability of the domestic fruit and vegetable supply and access.
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Carriedo A, Lock K, Knai C, Hawkins B. A qualitative analysis of the design and implementation of the soda tax in Mexico. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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McGill ET, Egan M, Lock K, Mountford L, Whitehead M, Petticrew M. How evidence on the social determinants of health is understood and utilised by non-health sector decision makers in four countries: qualitative findings. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lorenc T, Tyner E, Petticrew M, Martineau F, Phillips G, Lock K. PP71 Cultures of Evidence Among Decision-Makers in Non-Health Fields: Systematic Review of Qualitative Evidence. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Boets P, Holguin G, Lock K, Goethals P. Data-driven habitat analysis of the Ponto-Caspian amphipod Dikerogammarus villosus in two invaded regions in Europe. ECOL INFORM 2013. [DOI: 10.1016/j.ecoinf.2012.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martineau FP, Graff H, Mitchell C, Lock K. Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government. J Public Health (Oxf) 2013; 36:435-42. [PMID: 23933915 PMCID: PMC4181422 DOI: 10.1093/pubmed/fdt079] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action. Methods Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described. Results Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives—for example, minimum unit pricing licensing conditions—can serve as test cases for wider national implementation. Conclusions By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms.
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Phillips G, Hayes R, Bottomley C, Petticrew M, Watts P, Lock K, Clow A, Draper A, Moore D, Schmidt E, Tobi P, Lais S, Yu G, Barrow-Guevara G, Renton A. OP06 Well London: Results of a Cluster-Randomised Trial of a Community Development Approach to Improving Health Behaviours and Mental Wellbeing in Deprived Inner-City Neighbourhoods. J Epidemiol Community Health 2012. [DOI: 10.1136/jech-2012-201753.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lock K, Wilson K, Murphy D, Riesco JA. A cost-effectiveness model of smoking cessation based on a randomised controlled trial of varenicline versus placebo in patients with chronic obstructive pulmonary disease. Expert Opin Pharmacother 2011; 12:2613-26. [DOI: 10.1517/14656566.2011.628935] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Harris J, Felix L, Miners A, Murray E, Michie S, Ferguson E, Free C, Lock K, Landon J, Edwards P. Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis. Health Technol Assess 2011; 15:1-160. [PMID: 22030014 PMCID: PMC4781244 DOI: 10.3310/hta15370] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is 'e-learning', the use of interactive electronic media to facilitate teaching and learning on a range of issues including health. The high level of accessibility, combined with emerging advances in computer processing power, data transmission and data storage, makes interactive e-learning a potentially powerful and cost-effective medium for improving dietary behaviour. OBJECTIVE This review aims to assess the effectiveness and cost-effectiveness of adaptive e-learning interventions for dietary behaviour change, and also to explore potential psychological mechanisms of action and components of effective interventions. DATA SOURCES Electronic bibliographic databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Dissertation Abstracts, EMBASE, Education Resources Information Center, Global Health, Health Economic Evaluations Database, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science) were searched for the period January 1990 to November 2009. Reference lists of included studies and previous reviews were also screened; authors were contacted and trial registers were searched. REVIEW METHODS Studies were included if they were randomised controlled trials, involving participants aged ≥ 13 years, which evaluated the effectiveness of interactive software programs for improving dietary behaviour. Primary outcomes were measures of dietary behaviours, including estimated intakes or changes in intake of energy, nutrients, dietary fibre, foods or food groups. Secondary outcome measures were clinical outcomes such as anthropometry or blood biochemistry. Psychological mediators of dietary behaviour change were also investigated. Two review authors independently screened results and extracted data from included studies, with any discrepancies settled by a third author. Where studies reported the same outcome, the results were pooled using a random-effects model, with weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated. Cost-effectiveness was assessed in two ways: through a systematic literature review and by building a de novo decision model to assess the cost-effectiveness of a 'generic' e-learning device compared with dietary advice delivered by a health-care professional. RESULTS A total of 36,379 titles were initially identified by the electronic searches, of which 43 studies were eligible for inclusion in the review. All e-learning interventions were delivered in high-income countries. The most commonly used behavioural change techniques reported to have been used were goal setting; feedback on performance; information on consequences of behaviour in general; barrier identification/problem solving; prompting self-monitoring of behaviour; and instruction on how to perform the behaviour. There was substantial heterogeneity in the estimates of effect. E-learning interventions were associated with a WMD of +0.24 (95% CI 0.04 to 0.44) servings of fruit and vegetables per day; -0.78 g (95% CI -2.5 g to 0.95 g) total fat consumed per day; -0.24 g (95% CI -1.44 g to 0.96 g) saturated fat intake per day; -1.4% (95% CI -2.5% to -0.3%) of total energy consumed from fat per day; +1.45 g (95% CI -0.02 g to 2.92 g) dietary fibre per day; +4 kcal (95% CI -85 kcal to 93 kcal) daily energy intake; -0.1 kg/m2 (95% CI -0.7 kg/m2 to 0.4 kg/m2) change in body mass index. The base-case results from the E-Learning Economic Evaluation Model suggested that the incremental cost-effectiveness ratio was approximately £102,112 per quality-adjusted life-year (QALY). Expected value of perfect information (EVPI) analysis showed that although the individual-level EVPI was arguably negligible, the population-level value was between £37M and £170M at a willingness to pay of £20,000-30,000 per additional QALY. LIMITATIONS The limitations of this review include potential reporting bias, incomplete retrieval of completed research studies and data extraction errors. CONCLUSION The current clinical and economic evidence base suggests that e-learning devices designed to promote dietary behaviour change will not produce clinically significant changes in dietary behaviour and are at least as expensive as other individual behaviour change interventions. FUTURE WORK RECOMMENDATIONS Despite the relatively high EVPI results from the cost-effectiveness modelling, further clinical trials of individual e-learning interventions should not be undertaken until theoretically informed work that addresses the question of which characteristics of the target population, target behaviour, content and delivery of the intervention are likely to lead to positive results, is completed. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Phillips G, Watts P, Petticrew M, Lock K, Hayes R, Bottomley C, Yu G, Schmidt E, Moore D, Frostick C, Clow A, Lais S, Renton A. Determinants of mental health and wellbeing in low income communities: A multilevel approach examining individual and neighbourhood characteristics. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.143586.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Watts P, Phillips G, Petticrew M, Hayes R, Bottomley C, Yu G, Schmidt E, Moore D, Frostick C, Lock K, Renton A. Determinants of physical activity in deprived communities in London: Examining the effects of individual and neighbourhood characteristics. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.143586.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Crowley R, Wolfe I, Lock K, McKee M. Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child 2011; 96:548-53. [PMID: 21388969 DOI: 10.1136/adc.2010.202473] [Citation(s) in RCA: 431] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based. OBJECTIVES To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11-25 with chronic illness (physical or mental) or disability, and identify their successful components. DESIGN A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention. RESULTS 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures. CONCLUSIONS The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.
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Boets P, Lock K, Goethals PLM. Using long-term monitoring data to detect changes in macroinvertebrate species composition in the harbour of Ghent (Belgium). COMMUNICATIONS IN AGRICULTURAL AND APPLIED BIOLOGICAL SCIENCES 2011; 76:147-150. [PMID: 21539218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Sweet A, Lee D, Gairy K, Phiri D, Reason T, Lock K. The impact of CT colonography for colorectal cancer screening on the UK NHS: costs, healthcare resources and health outcomes. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2011; 9:51-64. [PMID: 21174482 DOI: 10.2165/11588110-000000000-00000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Biennial faecal occult blood testing (FOBT) for individuals aged 60-69 years is the primary screening tool for colorectal cancer (CRC) in the UK NHS, despite a large number of patients undergoing an unnecessary optical colonoscopy (OC) and evidence from modelling studies to suggest that more cost-effective technologies exist. CT colonography (CTC) is an emerging CRC screening technology with the potential to prevent CRC by detecting pre-cancerous polyps and to detect cancer at an earlier stage. OBJECTIVE to assess the impact of introducing CTC into the UK NHS screening programme for CRC on key health outcomes as well as the NHS budget and healthcare resource capacity. METHODS a discrete Markov model was used to reflect the natural history of CRC and the impact of three screening scenarios (biennial FOBT with and without CTC triage of patients referred to OC, and CTC every 5 years) on a range of health outcomes, including the incidence and prevalence of CRC, in a hypothetical cohort of individuals. The yearly costs, health outcomes and healthcare resource capacity requirements were estimated over a 10-year period (2009-18). RESULTS using CTC to follow up FOBT-positive patients (scenario 2) was less costly than directing all FOBT-positive patients to OC (scenario 1); saving £776 283 over 10 years for 100 000 individuals invited for screening (year 2007 values), primarily by avoiding approximately 1700 OCs, but was estimated to require 2200 additional CT scans. Implementing a programme of 5-yearly CTC as a primary screen is expected to be more expensive than FOBT screening over the short term (driven by high screening and diagnosis costs), despite substantial savings in treatment costs for CRC over the 10-year time horizon of the model and improved health outcomes. CONCLUSIONS adding CTC into the existing NHS Bowel Cancer Screening Programme as part of a preventive screening strategy could be less costly to the NHS over the longer term when used to triage FOBT-positive patients to appropriate follow-up. Increased demand for radiology services may be compensated for by reduced demand in endoscopy units.
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Lock K, Adams E, Pilkington P, Duckett K, Gilmore A, Marston C. Evaluating social and behavioural impacts of English smoke-free legislation in different ethnic and age groups: implications for reducing smoking-related health inequalities. Tob Control 2010; 19:391-7. [PMID: 20679418 DOI: 10.1136/tc.2009.032318] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore social and behavioural impacts of English smoke-free legislation (SFL) in different ethnic groups. DESIGN A longitudinal, qualitative panel study of smokers using in-depth interviews conducted before and after introduction of SFL. PARTICIPANTS A purposive sample of 32 smokers selected from three ethnic groups in deprived London neighbourhoods with approximately equal numbers of younger and older, male and female respondents. RESULTS SFL has had positive impacts with half smoking less and three quitting. Although there were no apparent differences in smoking and quitting behaviours between groups, there were notable differences in the social impacts of SFL. The greatest negative impacts were in smokers over 60 years, potentially increasing their social isolation, and on young Somali women whose smoking was driven more underground. In contrast, most other young adult smokers felt relatively unaffected by SFL, describing unexpected social benefits. Although there was high compliance, reports of illegal smoking were more frequent among young, ethnic minority smokers, with descriptions of venues involved suggesting they are ethnically distinct and well hidden. Half of respondents reported stopping smoking in their own homes after SFL, but almost all were Somali or Turkish. White respondents tended to report increases in home smoking. DISCUSSION Although our study suggests that SFL can lead to reductions in tobacco consumption, it also shows that impacts vary by ethnicity, age and sex. This study highlights the importance of understanding the meaning of smoking in different social contexts so future tobacco control interventions can be developed to reduce health and social inequalities.
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