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Ruswa N, Mavhunga F, Roscoe JC, Beukes A, Shipiki E, van Gorkom J, Sawadogo S, Agolory S, Menzies H, Tiruneh D, Makumbi B, Bayer B, Zezai A, Campbell P, Alexander H, Kalisvaart N, Forster N. Second nationwide anti-tuberculosis drug resistance survey in Namibia. Int J Tuberc Lung Dis 2020; 23:858-864. [PMID: 31439119 DOI: 10.5588/ijtld.18.0526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Namibia ranks among the 30 high TB burden countries worldwide. Here, we report results of the second nationwide anti-TB drug resistance survey.OBJECTIVE: To assess the prevalence and trends of multidrug-resistant TB (MDR-TB) in Namibia.METHODS: From 2014 to 2015, patients with presumptive TB in all regions of Namibia had sputum subjected to mycobacterial culture and phenotypic drug susceptibility testing (DST) for rifampicin, isoniazid, ethambutol and streptomycin if positive on smear microscopy and/or Xpert MTB/RIF.RESULTS: Of the 4124 eligible for culture, 3279 (79.5%) had Mycobacterium tuberculosis isolated. 3126 (95%) had a first-line DST completed (2392 new patients, 699 previously treated patients, 35 with unknown treatment history). MDR-TB was detected in 4.5% (95%CI 3.7-5.4) of new patients, and 7.9% (95%CI 6.0-10.1) of individuals treated previously. MDR-TB was significantly associated with previous treatment (OR 1.8, 95%CI 1.3-2.5) but not with HIV infection, sex, age or other demographic factors. Prior treatment failure demonstrated the strongest association with MDR-TB (OR 17.6, 95%CI 5.3-58.7).CONCLUSION: The prevalence of MDR-TB among new TB patients in Namibia is high and, compared with the first drug resistance survey, has decreased significantly among those treated previously. Namibia should implement routine screening of drug resistance among all TB patients.
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Affiliation(s)
- N Ruswa
- Ministry of Health and Social Services, Windhoek, Namibia, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - F Mavhunga
- Ministry of Health and Social Services, Windhoek, Namibia
| | - J C Roscoe
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Beukes
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Shipiki
- Namibia Institute of Pathology, Windhoek, Namibia
| | - J van Gorkom
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - S Sawadogo
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Agolory
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Menzies
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Tiruneh
- World Health Organization, Geneva, Switzerland
| | - B Makumbi
- Namibia Institute of Pathology, Windhoek, Namibia
| | - B Bayer
- Ministry of Health and Social Services, Windhoek, Namibia
| | - A Zezai
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - P Campbell
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Alexander
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Kalisvaart
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - N Forster
- Ministry of Health and Social Services, Windhoek, Namibia, International Training & Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA
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Lhussier M, Forster N. Understanding place-based public health to reduce inequalities in the context of austerity. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ageing populations and increased prevalence of long-term conditions, combined with reduced public funding following the financial crisis mean health needs often outstrip provision. Furthermore, austerity policies across Europe have been associated with a steep rise in health inequalities.
Methods
A comparative case study design, drawing on realist evaluation, examines the place-based strategies used by five UK Local Authorities (LAs) to maximise resources and reduce health inequalities. LAs were selected based on their implementation of innovative interventions and/or their experience of better or worse than expected trends in reducing health inequalities. Initial programme theories (IPTs) were developed through stakeholder consultation and literature searches, which will be tested and refined using case study data. Data collection methods are tailored to each case study context, but include: documentary analysis; system mapping exercises; and interviews with stakeholders and community members.
Preliminary Results
Initial programme theories were developed detailing the place-based strategies that are most effective in maximising resources and improving health outcomes, depending on contextual conditions. These theories cover strategies such as income generation schemes to supplement taxation; the introduction of ’disruptive’ voices into decision processes; outsourcing and widening skill-sets; reviewing and streamlining resources; and the development of tightly defined targets.
Conclusions
There is currently a lack of guidance on the optimal allocation of limited resources and effective delivery of services and interventions in contexts of reduced spending. Employing a realist approach has enabled us to move beyond the particularities of local contexts and strategies to produce pragmatic and transferable solutions which can inform the funding decisions of local government.
Key messages
LAs have to innovate to balance growing needs with shrinking resources. Pragmatic lessons are drawn to inform decision making applicable beyond local contextual specificities.
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Affiliation(s)
- M Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - N Forster
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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3
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Lhussier M, Forster N, Haighton K, Egan M, Woodhead C, Webb C, Poole L, Carr SM, Dalkin S, Brown H. Setting the agenda for further research on health and welfare. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Given the recognised relationship between poverty, welfare provision and health, welfare rights advice has emerged as a potentially key intervention in improving health and reducing inequalities. The generation of evidence in this area has proven difficult however, creating a need to take stock of existing research and develop an agenda for future work.
Methods
A series of four workshops was convened involving researchers from four UK universities who had previously undertaken work examining the relationship between welfare advice and health, from a range of methodological perspectives. Run concurrently to a scoping of the literature, these workshops aimed to synthesise lessons from prior research; formulate outstanding research questions; and outline potential methodological approaches for addressing these. A survey was undertaken with professionals (from welfare or legal advice sectors, the health sector, commissioning, local government, and housing services, n = 50) to test out, refine and add to these research questions.
Results
Key research questions developed from these workshops were: Are there inequalities in the impact and reach of advice services across social groups? How/ does advice delivery mode matter?What are the individual and system level impacts of the de-implementation of advice services?What are the impacts of changes to welfare provision on children, inter-generationally and throughout the life course?How do experiences of social welfare vary by social group, geographically and across generations? How do different identities combine to influence how social welfare is understood?
Conclusions
While the collaborative process brought challenges in balancing research and practitioner expertise, this model of working has been successful in setting an agenda for further research with maximum utility to practice. Direct outputs from the projects have been the collaborative submission of a journal article and a research bid.
Key messages
The collaboration, which was supported by the NIHR School of Public Health Research, led to the establishment of a concise research agenda. Through extensive stakeholder consultation, this will have maximal utility for practice.
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Affiliation(s)
- M Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - N Forster
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - K Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - M Egan
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - C Woodhead
- Institute of Epidemiology & Health, University College London, London, UK
| | - C Webb
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - L Poole
- Advice Services Alliance, London, UK
| | - S M Carr
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - S Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - H Brown
- Institute of Health and Society, Newcastle University, Newcastle, UK
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4
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Forster N, Lhussier M, Woodhead C, Barnes A, Carr SM, Haighton K. A taxonomy of mechanisms underpinning the impact of welfare rights advice on health. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Welfare rights advice has potential to help address the social determinants of health and reduce inequalities. Existing logic models identify the sequence of proximal to distal outcomes following welfare advice, but attribution remains challenging. This paper reports on the contextual influences and key mechanisms leading to health outcomes.
Methods
We undertook comprehensive searches of the literature addressing the links between welfare advice and health. Titles and abstracts were screened first, then full text, using inclusion and exclusion criteria. Employing a realist logic of analysis, data extraction and synthesis focused on disentangling evidence of how and why advice improves (or not) health related outcomes, depending on the context. These insights were then paired with existing theory (either explicitly referenced or inferred by authors), in order to produce a robust explanatory model of when and how advice leads to improved health.
Results
59 articles were included in the analysis. Preliminary findings point to the significance of target group in influencing the types of outcomes achieved. Fineman’s (2013) typology of embodied, situational and structural vulnerability helped explain the differential impact of advice. Where people experience embodied vulnerabilities, such as life-limiting illness or disabling physical or mental health conditions, advice may increase quality of life, but is less likely to improve existing health status. Likewise, advice interventions alone are unlikely to alter health outcomes stemming from entrenched structural disadvantages such as poverty or discrimination, and appear to be most effective in addressing situational vulnerabilities generated more temporarily by difficult circumstances.
Conclusions
The review provides a more nuanced understanding of how and why welfare advice may impact on health. These insights will help to more appropriately target, tailor and monitor the health impact of welfare advice.
Key messages
Welfare advice has differential impact, depending on specific client vulnerabilities. This highlights the importance of appropriate targeting, and selecting suitable measures of success.
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Affiliation(s)
- N Forster
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - M Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - C Woodhead
- Institute of Epidemiology & Health, University College London, London, UK
| | - A Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S M Carr
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - K Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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5
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Tighe M, Forster N, Guppy C, Savage D, Grave P, Young IM. Georeferenced soil provenancing with digital signatures. Sci Rep 2018; 8:3162. [PMID: 29453358 PMCID: PMC5816621 DOI: 10.1038/s41598-018-21530-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
Abstract
The provenance or origin of a soil sample is of interest in soil forensics, archaeology, and biosecurity. In all of these fields, highly specialized and often expensive analysis is usually combined with expert interpretation to estimate sample origin. In this proof of concept study we apply rapid and non-destructive spectral analysis to the question of direct soil provenancing. This approach is based on one of the underlying tenets of soil science – that soil pedogenesis is spatially unique, and thus digital spectral signatures of soil can be related directly, rather than via individual soil properties, to a georeferenced location. We examine three different multivariate regression techniques to predict GPS coordinates in two nested datasets. With a minimum of data processing, we show that in most instances Eastings and Northings can be predicted to within 20% of the range of each within the dataset using the spectral signatures produced via portable x-ray fluorescence. We also generate 50 and 95% confidence intervals of prediction and express these as a range of GPS coordinates. This approach has promise for future application in soil and environmental provenancing.
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Affiliation(s)
- M Tighe
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia.
| | - N Forster
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - C Guppy
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia
| | - D Savage
- 138 Toms Gully Road, Black Mountain, NSW 2365, Australia
| | - P Grave
- Archaeomaterials Science Hub, Archaeology & Palaeoanthropology, University of New England, Armidale, NSW 2351, Australia
| | - I M Young
- Sydney Institute of Agriculture, School of Life and Environmental Sciences, University of Sydney, Camperdown, NSW 2006, Australia
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6
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Forster N, Lhussier M, Dalkin S, Hodgson P, Carr S. Public health interventions targeting excluded groups: trust as a key factor for success. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Forster
- Northumbria University, Newcastle, UK
| | | | - S Dalkin
- Northumbria University, Newcastle, UK
| | - P Hodgson
- Northumbria University, Newcastle, UK
| | - S Carr
- Northumbria University, Newcastle, UK
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7
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Lhussier M, Dalkin S, Forster N, Hodgson P, Carr S. Exposing the health impacts of welfare advice in an age of austerity: a UK based study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Lhussier
- Northumbria University, Newcastle upon Tyne, UK
| | - S Dalkin
- Northumbria University, Newcastle upon Tyne, UK
| | - N Forster
- Northumbria University, Newcastle upon Tyne, UK
| | - P Hodgson
- Northumbria University, Newcastle upon Tyne, UK
| | - S Carr
- Northumbria University, Newcastle upon Tyne, UK
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8
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Forster N. Knocking on wood and bucking up your ideas: control and fatalism in Gypsy and Traveller health. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Forster
- University of Edinburgh, Edinburgh, UK
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9
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Abstract
INTRODUCTION Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. METHODS AND ANALYSIS A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted.
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Affiliation(s)
- N Forster
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - S M Dalkin
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - M Lhussier
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - P Hodgson
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - S M Carr
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
- Federation University, Australia
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10
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Jiang D, Mierzwa M, Huth B, Xie C, Barrett W, Redmond K, Forster N. Does Time of Daily Treatment Matter in Radiation Therapy for Head and Neck Cancer? Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Background Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities. Methods A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken. Results An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A ‘menu’ of reasoning mechanisms is presented, leading to key engagement outcomes. Conclusions Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.
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Affiliation(s)
- M Lhussier
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK
| | - S M Carr
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK Faculty of Health, Federation University, Australia
| | - N Forster
- Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus East (H012), Newcastle upon Tyne NE7 7XA, UK Fuse, the Centre for Translational Research in Public Health, UK
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12
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Rohrer-Mirtschink S, Forster N, Giovanoli P, Guggenheim M. Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland. Ann Burns Fire Disasters 2015; 28:71-75. [PMID: 26668566 PMCID: PMC4665187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/22/2014] [Accepted: 11/20/2014] [Indexed: 06/05/2023]
Abstract
In Switzerland it is customary to light candles on Christmas trees and advent wreaths. This tradition leads to an increased risk of home fires. We reviewed the records of patients who sustained burn injuries from a lit Christmas tree or advent wreath during the Christmas holidays between January 1971 and January 2012. We treated 28 patients and observed 4 fatalities (mortality rate: 14%). 61% of the patients were male, 39% were female. The mean abbreviated burn severity index (ABSI) was 6.5 points in the group of the survivors and 10.8 points in the group of the non-survivors. The mean total body surface area burned (TBSA) for survivors was 18.9%, with 14.1% having full thickness burns; for the non-survivors the mean TBSA was 45.2%, with 38% having full thickness burns. The Mann-Whitney U-test showed a significant difference between the survivors and the fatalities concerning the mean total and full thickness burned body surface area (p value 0.009 and 0.012). More than sixty percent of the fires occurred in January and the most severe accidents were seen after January 4th. Despite Christmas decoration-associated fires being relatively uncommon, they tend to cause more serious injuries than regular household fires. We recommend that in countries where it is customary to set up flammable Christmas decorations, state-issued information pamphlets with instructions on fire safety conduct should be distributed.
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Affiliation(s)
- S. Rohrer-Mirtschink
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - N. Forster
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
- Department of Plastic Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - P. Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
| | - M. Guggenheim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Switzerland
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Carr SM, Lhussier M, Forster N, Goodall D, Pennington M, Geddes L, Bancroft A, Adams J, Michie S. A realist synthesis of international evidence on outreach interventions to improve the health of Traveller Communities. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carr SM, Lhussier M, Forster N, Geddes L, Deane K, Pennington M, Visram S, White M, Michie S, Donaldson C, Hildreth A. An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technol Assess 2011; 15:iii-iv, 1-284. [PMID: 21329611 DOI: 10.3310/hta15090] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a need to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK, with particular reference to the reduction of inequalities. OBJECTIVES To identify the component intervention techniques of lifestyle advisors (LAs) in the UK and similar contexts, and the outcomes of HRLA interventions. DATA SOURCES Stakeholder views, secondary analysis of the National Survey of Health Trainer Activity, telephone survey of health trainer leads/coordinators. A search of a range of electronic databases was undertaken [including the Applied Social Sciences Index and Abstracts (ASSIA), EMBASE, NHS Economic Evaluation Database (NHS EED), MEDLINE, Psyc INFO, etc.], as well searching relevant journals and reference lists, conducted from inception to September 2008. REVIEW METHODS Identified studies were scanned by two reviewers and those meeting the following criteria were included: studies carrying out an evaluation of HRLA; those taking place in developed countries similar to the UK context; those looking at adult groups; interventions with the explicit aim of health improvement; interventions that involved paid or voluntary work with an individual or group of peers acting in an advisory role; advice delivered by post, online or electronically; training, support or counselling delivered to patients, communities or members of the public. After quality assessment, studies were selected for inclusion in the review. Data were abstracted from each study according to an agreed procedure and narrative, and realist and economic approaches were used to synthesise the data. Cost-effectiveness analysis of interventions was undertaken. RESULTS In total, 269 studies were identified but 243 were excluded. The 26 included studies addressing chronic care, mental health, breastfeeding, smoking, diet and physical activity, screening and human immunodeficiency virus (HIV) infection prevention. Overall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL), and thus uncertainty about the interventions' cost-effectiveness. However, the economic analysis showed that LA interventions were cost-effective in chronic care and smoking cessation, inconclusive for breastfeeding and mental health and not cost-effective for screening uptake and diet/physical activity. LA interventions for HIV prevention were cost-effective, but not in a UK context. LIMITATIONS The wide variety of LA models, delivery settings and target populations prevented the reviewers from establishing firm causal relationships between intervention mode and study outcomes. CONCLUSIONS Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. Reporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions. A future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence. FUNDING This study was funded by the Health Technology Assessment programme of the National Institute for Health Research.
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Affiliation(s)
- S M Carr
- Northumbria University, Newcastle upon Tyne, UK
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Hussey A, Winardi M, Wilson J, Forster N, Morrison W, Penington A, Knight K, Feeney S. Pancreatic Islet Transplantation Using Vascularised Chambers Containing Nerve Growth Factor Ameliorates Hyperglycaemia in Diabetic Mice. Cells Tissues Organs 2010; 191:382-93. [DOI: 10.1159/000276595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2009] [Indexed: 11/19/2022] Open
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16
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Contaldo C, Fanfan C, Forster N, Vetter S, Lindenblatt N, Calcagni M, Giovanoli P. Effects of Extracorporeal Shock Wave Energy on Normal Murine Microcirculation. J Plast Reconstr Aesthet Surg 2009. [DOI: 10.1016/j.bjps.2009.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Forster N, Haddad RL, Choroomi S, Dilley AV, Pereira J. Use of ultrasound in 187 infants with suspected infantile hypertrophic pyloric stenosis. ACTA ACUST UNITED AC 2008; 51:560-3. [PMID: 17958692 DOI: 10.1111/j.1440-1673.2007.01872.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnostic efficacy of ultrasound (US) in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) was evaluated, with particular attention paid to whether prematurity, age or weight correlate significantly to the sonographic measurements. The medical records of 187 infants with suspected IHPS were reviewed retrospectively. Eighty-seven had an US examination with details of the pylorus. Fifty-nine of these gave a positive diagnosis. The US criteria for a positive diagnosis were pyloric muscle thickness (PMT)>or=3 mm and pyloric muscle length (PML)>or=17 mm. The mean overall PMT was 4.14 mm and mean overall PML was 18.99 mm. Premature infants had a lower mean PML (17.8 mm) than the term infants (PML mean 19.3 mm); however, this was not significant (t-value 1.92, P=0.062). The sensitivity and specificity of PMT was 91 and 85%, respectively, and of PML 76 and 85%, respectively. The ability of US to diagnose IHPS using our criteria was significant (t-value, PMT 14.93 and PML 6.89; P<0.0001). There was no significant correlation between age, weight or prematurity and a sonographic diagnosis of IHPS (Pearson's coefficient<0.3). Therefore, the same US criteria should apply irrespective of prematurity, age or weight. Borderline PMT and PML measurements necessitate repeat US or alternative imaging.
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Affiliation(s)
- N Forster
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Dennington S, Dianda J, Forster N, Hill BT. Cultural diversity. Clin Lab Manage Rev 1993; 7:256-9. [PMID: 10126516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- S Dennington
- George Washington University Medical Center, Washington, DC
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